Provider Demographics
NPI:1033266119
Name:SIMMONS, JANICE ANITA (OD)
Entity type:Individual
Prefix:DR
First Name:JANICE
Middle Name:ANITA
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:ANITA
Other - Last Name:SIMMONS-SHIELDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:
Practice Address - Street 1:10050 BALTIMORE NATIONAL PIKE STE F100
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-3684
Practice Address - Country:US
Practice Address - Phone:410-461-2020
Practice Address - Fax:410-394-8054
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1197152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD907595000Medicaid
MDU95710Medicare UPIN