=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801826656
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICHARD S SIMON OD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/04/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2021 L ST NW
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20036-4909
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-659-5575
-----------------------------------------------------
Fax | 202-296-9678
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2021 L ST NW
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20036-4909
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-659-5575
-----------------------------------------------------
Fax | 202-296-9678
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152WC0802X
-----------------------------------------------------
Taxonomy Name | Corneal and Contact Management Optometrist
-----------------------------------------------------
License Number | OP569
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------