Healthcare Provider Details

I. General information

NPI: 1316875412
Provider Name (Legal Business Name): SIMRAN WALIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 W 42ND ST
NEW YORK NY
10036-8005
US

IV. Provider business mailing address

271 MCWALTER DR
ROSELLE IL
60172-4911
US

V. Phone/Fax

Practice location:
  • Phone: 212-938-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number011498
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: