Individual
JONATHAN SIMMONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OPTOMETRIST
Contact information
Practice address
219 W. CHESTNUT, MARIANNA, AR 72360
(870) 295-3636
Mailing address
219 W CHESTNUT ST, MARIANNA, AR 72360-2212
(870) 295-3636
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2390
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
119930722
—
AR
01
—
48355G067
MEDICARE GROUP
AR
Enumeration date
08/01/2006
Last updated
08/30/2010
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