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General NPI Number Information
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NPI Number | 1225125644
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Entity Type | Organization
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Legal Business Name | SUE C. SIMPSON
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 01/07/2020
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Provider Practice Location Address
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Address Line | 2320 E VILLA MARIA RD
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City | BRYAN
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State | TX
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Zip | 77802-2549
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Country | US
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Telephone | 979-779-9000
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Fax | 979-775-2020
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Provider Business Mailing Address
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Address Line | 2320 E VILLA MARIA RD
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City | BRYAN
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State | TX
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Zip | 77802-2549
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Country | US
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Telephone | 979-779-9000
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Fax | 979-775-2020
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Authorized Official
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Title or Position | DOCTOR
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Name | SUE CAMPBELL SIMPSON
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Credential | O.D.
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Telephone | 979-779-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3095TG
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License Number State | TX
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