Healthcare Provider Details

I. General information

NPI: 1659378537
Provider Name (Legal Business Name): JOHN P SIMSES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 10/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 HAWLEY LN STE 107
TRUMBULL CT
06611-5379
US

IV. Provider business mailing address

160 HAWLEY LN STE 107
TRUMBULL CT
06611-5379
US

V. Phone/Fax

Practice location:
  • Phone: 203-378-3224
  • Fax: 203-378-2968
Mailing address:
  • Phone: 203-378-3224
  • Fax: 203-378-2968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number016067
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: