Provider Demographics
NPI:1538415674
Name:SIMMONS, NANCY ANN (OD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:ANN
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23762 MILL ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-2335
Mailing Address - Country:US
Mailing Address - Phone:320-420-1318
Mailing Address - Fax:320-323-4470
Practice Address - Street 1:1447 E 7TH ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MN
Practice Address - Zip Code:55362-4666
Practice Address - Country:US
Practice Address - Phone:763-295-5600
Practice Address - Fax:320-323-4470
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-26
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN3282152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3282OtherSTATE LICENSE