Healthcare Provider Details

I. General information

NPI: 1619963733
Provider Name (Legal Business Name): STEPHEN N SIMPSON O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 09/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2417 W FRANKLIN ST
EVANSVILLE IN
47712-5564
US

IV. Provider business mailing address

2417 W FRANKLIN ST
EVANSVILLE IN
47712-5564
US

V. Phone/Fax

Practice location:
  • Phone: 812-423-5000
  • Fax: 812-423-6838
Mailing address:
  • Phone: 812-423-5000
  • Fax: 812-423-6838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18002839A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: