Individual
MR. MARTIN BRUCE SIMMONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
4021 FAR HILLS AVE, KETTERING, OH 45429-2413
(937) 293-2149
(937) 395-9633
Mailing address
311 W 24TH ST STE 401, ERIE, PA 16502-2667
(814) 455-7591
(814) 454-1467
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
OEG000681
PA
152W00000X
Optometrist
Primary
OPT006726
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1016403560001
—
PA
01
—
1315299
AETNA HMO
PA
01
—
180649
HIGHMARK BLUE SHIELD
PA
01
—
1863649
KEYSTONE SR BLUE
PA
01
—
27541
HLTH ASSURANCE
PA
01
—
5106063
AETNA PPO
PA
Enumeration date
07/06/2006
Last updated
11/25/2019
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