MEDICARE: SIMPLE OPTICAL, INC

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

General Provider Information

NPI Number	:	1780393264
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIMPLE OPTICAL, INC

Provider Business Mailing Address
First Line	:	1057 W CENTURY DR APT 118
Second Line	:
City	:	LOUISVILLE
State	:	CO
Zip	:	80027-1639
Country	:	US
Telephone Number	:	303-601-1982
Fax Number	:

Provider Business Practice Location Address
First Line	:	6460 E YALE AVE UNIT A20
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-7145
Country	:	US
Telephone Number	:	720-316-7739
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PHILIP WREN
Credential	:	OD
Telephone Number	:	303-601-1982

Provider Enumeration Date	:	11/23/2022
Last Update Date	:	11/23/2022

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Directions to “SIMPLE OPTICAL, INC ” Practice Location

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