Basic Information
| Provider Information | |||||||||
| NPI: | 1689633877 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIMMONS | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12 N 1100 E | ||||||||
| Address2: | |||||||||
| City: | AMERICAN FORK | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840032952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017569627 | ||||||||
| FaxNumber: | 8017630126 | ||||||||
| Practice Location | |||||||||
| Address1: | 12 N 1100 E | ||||||||
| Address2: | |||||||||
| City: | AMERICAN FORK | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840032952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017569627 | ||||||||
| FaxNumber: | 8017630126 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2006 | ||||||||
| LastUpdateDate: | 10/11/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 114653-9934 | UT | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 1689633877 | 05 | UT | MEDICAID | 164679 | 01 | UT | DMBA | OTHER | 275926 | 01 | UT | ALTIUS | OTHER | 87688 | 01 | UT | PEHP | OTHER | 87028357684003A004 | 01 | UT | TRICARE | OTHER |