Active NPI
Derrick Floyd Simmons, O.D.
- Optometrist
- Port Neches, TX
National Provider Identifier
1053485276
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 3127 TG
- Practice address
- 1810 Magnolia Ave
Port Neches, TX 77651-4018 - Phone
- (409) 721-6972
- Fax
- (409) 721-5492
- NPI assigned
- Nov 20, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 3127 TG | TX | Primary |
Addresses
Primary practice location
1810 Magnolia Ave
Port Neches, TX 77651-4018
Mailing address
1810 Magnolia Ave
Port Neches, TX 77651-4018
Phone (409) 721-6972
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3217TG | Other | TX | LICENSE # |
| 76-0115941 | Other | TX | TAX ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120315000625 | TX | Practitioner - Optometry | 6507025269 | Practice locations: Port Neches, TX |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3217 | TX | MD | Behavioral Analyst |
| 3127 TG | TX | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163980800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1341964800000",
"number": "1053485276",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1810 MAGNOLIA AVE",
"city": "PORT NECHES",
"state": "TX",
"postal_code": "776514018",
"telephone_number": "409-721-6972",
"fax_number": "409-721-5492"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1810 MAGNOLIA AVE",
"city": "PORT NECHES",
"state": "TX",
"postal_code": "776514018",
"telephone_number": "409-721-6972",
"fax_number": "409-721-5492"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIMMONS",
"first_name": "DERRICK",
"middle_name": "FLOYD",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-20",
"last_updated": "2012-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "TX",
"license": "3127 TG",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE #",
"identifier": "3217TG",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "76-0115941",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Port Neches, TX
- Brandon Michael Roberts, M.ED., NCC, LPC
- Misti Michelle Sanchez, RD, LD, CSP
- Erin Rutledge Shaw, FNP-C
- Lisa L Shoemaker
- Cristina Sifuentes-Ayala, PA-C, MS,RD,IBCLC
- Tempis Sinette
- Sonali Vijesh Patel MD PLLC
- Southeast Texas Women's Health PA
- Samuel Robert Stafford, PHARM.D.
- Christina L Stagg, R.D., L.D.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.