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	152W00000X	Optometrist
2	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1912099276
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
Country	:	US
Telephone Number	:	847-426-0227
Fax Number	:

Provider Business Practice Location Address
First Line	:	650 SPRING HILL RING RD
Second Line	:	SUITE 2020
City	:	WEST DUNDEE
State	:	IL
Zip	:	60118-1296
Country	:	US
Telephone Number	:	847-426-0227
Fax Number	:

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

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	12/17/2021

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