Provider Demographics
NPI:1609983337
Name:SIMMONS, THELA D (OD)
Entity type:Individual
Prefix:DR
First Name:THELA
Middle Name:D
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:PO BOX 2237
Mailing Address - Street 2:
Mailing Address - City:PAMPA
Mailing Address - State:TX
Mailing Address - Zip Code:79066-2237
Mailing Address - Country:US
Mailing Address - Phone:806-665-0771
Mailing Address - Fax:806-665-3511
Practice Address - Street 1:1324 N BANKS ST
Practice Address - Street 2:
Practice Address - City:PAMPA
Practice Address - State:TX
Practice Address - Zip Code:79065-4106
Practice Address - Country:US
Practice Address - Phone:806-665-0771
Practice Address - Fax:806-665-3511
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1971T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4628101OtherAETNA
TX80327EOtherBLUE CROSS BLUE SHIELD
TX020190701Medicaid
TX124055100OtherS.W. LIFE AND HEALTH
TX80327EOtherBLUE CROSS BLUE SHIELD