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NPI Code Detail

MEDICARE: DR. BRENDA SIMONS O.D.

MEDICARE:  DR. BRENDA  SIMONS  O.D.
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
1152W00000XOptometrist046007062IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1447243464
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRENDA SIMONS O.D.
Provider Business Mailing Address
First Line : 1700 E WEST RD
Second Line :
City : CALUMET CITY
State : IL
Zip : 60409-5415
Country : US
Telephone Number : 708-891-3330
Fax Number : 708-891-0904
Provider Business Practice Location Address
First Line : 1700 E WEST RD
Second Line :
City : CALUMET CITY
State : IL
Zip : 60409-5415
Country : US
Telephone Number : 708-891-3330
Fax Number : 708-891-0904
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2005
Last Update Date : 02/25/2014

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Directions to “ DR. BRENDA SIMONS O.D.” Practice Location

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