Healthcare Provider Details

I. General information

NPI: 1053553719
Provider Name (Legal Business Name): CLINT DOUGLAS SIMPSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2009
Last Update Date: 09/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 LAKE LANSING RD STE H
LANSING MI
48912-3752
US

IV. Provider business mailing address

850 W NORTH ST STE 104
JACKSON MI
49202-3196
US

V. Phone/Fax

Practice location:
  • Phone: 517-487-6511
  • Fax: 517-487-3415
Mailing address:
  • Phone: 877-852-8463
  • Fax: 517-817-0144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number4301094332
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: