Healthcare Provider Details

I. General information

NPI: 1649274366
Provider Name (Legal Business Name): PATRICIA HELEN SIMPSON O. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 04/13/2021
Certification Date: 04/13/2021
Deactivation Date: 03/16/2006
Reactivation Date: 03/20/2006

III. Provider practice location address

20 E NORTH ST
COAL CITY IL
60416-1087
US

IV. Provider business mailing address

1950 OLD GALLOWS RD # SUIE520
VIENNA VA
22182-3990
US

V. Phone/Fax

Practice location:
  • Phone: 815-634-4825
  • Fax: 815-634-4938
Mailing address:
  • Phone: 703-847-8899
  • Fax: 571-223-6780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046007569
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: