MEDICARE: SUE C. SIMPSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	3095TG	TX

General Provider Information

NPI Number	:	1225125644
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUE C. SIMPSON

Provider Business Mailing Address
First Line	:	2320 E VILLA MARIA RD
Second Line	:
City	:	BRYAN
State	:	TX
Zip	:	77802-2549
Country	:	US
Telephone Number	:	979-779-9000
Fax Number	:	979-775-2020

Provider Business Practice Location Address
First Line	:	2320 E VILLA MARIA RD
Second Line	:
City	:	BRYAN
State	:	TX
Zip	:	77802-2549
Country	:	US
Telephone Number	:	979-779-9000
Fax Number	:	979-775-2020

Authorized Official
Title or Position	:	DOCTOR
Name	:	SUE CAMPBELL SIMPSON
Credential	:	O.D.
Telephone Number	:	979-779-9000

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	01/07/2020

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