MEDICARE: SIMPSON EYE ASSOCIATES LTD

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1851348601
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIMPSON EYE ASSOCIATES LTD

Provider Business Mailing Address
First Line	:	650 SPRINGHILL RING RD
Second Line	:	SUITE #2020
City	:	WEST DUNDEE
State	:	IL
Zip	:	60118-1296
Country	:	US
Telephone Number	:	847-426-0227
Fax Number	:	847-426-0299

Provider Business Practice Location Address
First Line	:	730 E TERRA COTTA AVE
Second Line	:	SUITE 2B
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-3615
Country	:	US
Telephone Number	:	815-455-0212
Fax Number	:	815-455-4903

Authorized Official
Title or Position	:	CEO
Name	:	DR. KENNETH VICTOR MELCHIONNA
Credential	:	D.O.
Telephone Number	:	847-426-0227

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	03/05/2009

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