=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225252943
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BARRETT SIMPSON, O.D. LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3200 KEN BALE BLVD
-----------------------------------------------------
City | BOWLING GREEN
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42103-6025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-793-0958
-----------------------------------------------------
Fax | 270-781-7933
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5816 HIGHWAY 259 NORTH
-----------------------------------------------------
City | SWEEDEN
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42285
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-286-0276
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. CHARLES BARRETT SIMPSON
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 270-793-0958
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 1554DT
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------