MEDICARE: DR. SIMON RONALD ZMYSLINSKI 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
1	152W00000X	Optometrist	AZ1051	AZ

General Provider Information

NPI Number	:	1477613024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SIMON RONALD ZMYSLINSKI O.D.

Provider Business Mailing Address
First Line	:	9617 N METRO PKWY W
Second Line	:	1000
City	:	PHOENIX
State	:	AZ
Zip	:	85051-1400
Country	:	US
Telephone Number	:	602-678-4395
Fax Number	:	602-678-4396

Provider Business Practice Location Address
First Line	:	9617 N METRO PKWY W
Second Line	:	1000
City	:	PHOENIX
State	:	AZ
Zip	:	85051-1400
Country	:	US
Telephone Number	:	602-678-4395
Fax Number	:	602-678-4396

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

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	07/08/2007

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