Healthcare Provider Details

I. General information

NPI: 1407251663
Provider Name (Legal Business Name): SIMPSON AND MANN OPTOMETRY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2014
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9675 MONTE VISTA AVE STE B
MONTCLAIR CA
91763-2213
US

IV. Provider business mailing address

9675 MONTE VISTA AVE STE B
MONTCLAIR CA
91763-2213
US

V. Phone/Fax

Practice location:
  • Phone: 909-986-0918
  • Fax: 909-984-4918
Mailing address:
  • Phone: 909-986-0918
  • Fax: 909-984-4918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5737 TPG
License Number StateCA

VIII. Authorized Official

Name: DR. STUART MARK MANN
Title or Position: PRESIDENT
Credential: O.D.
Phone: 909-986-0918