MEDICARE: DR. DAVID A SIMONSON OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2357	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00743735	OTHER	CO	RAILROAD MEDICARE MEMBER PTAN

General Provider Information

NPI Number	:	1356314744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID A SIMONSON OD

Provider Business Mailing Address
First Line	:	301 DENVER AVE
Second Line	:
City	:	FORT LUPTON
State	:	CO
Zip	:	80621-1821
Country	:	US
Telephone Number	:	303-857-6550
Fax Number	:	303-857-6596

Provider Business Practice Location Address
First Line	:	301 DENVER AVE
Second Line	:
City	:	FORT LUPTON
State	:	CO
Zip	:	80621-1821
Country	:	US
Telephone Number	:	303-857-6550
Fax Number	:	303-857-6596

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	05/19/2023

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