Healthcare Provider Details

I. General information

NPI: 1093957888
Provider Name (Legal Business Name): SIMPSON & DURAN OPTOMETRY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2009
Last Update Date: 08/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 W 6TH ST SUITE 150
ONTARIO CA
91762-1121
US

IV. Provider business mailing address

1131 W 6TH ST SUITE 150
ONTARIO CA
91762-1121
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 TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6806
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number12804
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6807
License Number StateCA

VIII. Authorized Official

Name: MS. SANDY OJEDA
Title or Position: BILLING DEPARTMENT
Credential: D.O
Phone: 909-986-0918