1619963733 NPI number — STEPHEN N SIMPSON O.D.

Table of content: STEPHEN N SIMPSON O.D. (NPI 1619963733)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619963733 NPI number — STEPHEN N SIMPSON O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMPSON
Provider First Name:
STEPHEN
Provider Middle Name:
N
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619963733
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2417 W FRANKLIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANSVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47712-5564
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-423-5000
Provider Business Mailing Address Fax Number:
812-423-6838

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2417 W FRANKLIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EVANSVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47712-5564
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-423-5000
Provider Business Practice Location Address Fax Number:
812-423-6838
Provider Enumeration Date:
09/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  18002839A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 24048 . This is a "SPECTERA" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 1177350001 . This is a "DMERC REGION B" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 180567 . This is a "HIGHMARK CLARITY VISION" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200118870A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000092506 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 410033865 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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