Healthcare Provider Details

I. General information

NPI: 1851348601
Provider Name (Legal Business Name): SIMPSON EYE ASSOCIATES LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 03/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 E TERRA COTTA AVE SUITE 2B
CRYSTAL LAKE IL
60014-3615
US

IV. Provider business mailing address

650 SPRINGHILL RING RD SUITE #2020
WEST DUNDEE IL
60118-1296
US

V. Phone/Fax

Practice location:
  • Phone: 815-455-0212
  • Fax: 815-455-4903
Mailing address:
  • Phone: 847-426-0227
  • Fax: 847-426-0299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. KENNETH VICTOR MELCHIONNA
Title or Position: CEO
Credential: D.O.
Phone: 847-426-0227