Individual
SAMUEL RAY SIMMONS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
3411 N ANTHONY BLVD, FORT WAYNE, IN 46805-2233
(260) 482-1707
(260) 482-1707
Mailing address
3411 N ANTHONY BLVD, FORT WAYNE, IN 46805-2233
(260) 482-1707
(260) 482-1707
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18001933A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02049
SPECTERA INSURANCE
IN
01
—
135021
EYEMED INSURANCE
IN
Enumeration date
10/31/2006
Last updated
07/09/2007
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