Provider Demographics
NPI:1144359159
Name:SIMPSON, RORY WAYNE (OD)
Entity type:Individual
Prefix:DR
First Name:RORY
Middle Name:WAYNE
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 SADIE LN
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-1165
Mailing Address - Country:US
Mailing Address - Phone:304-692-2617
Mailing Address - Fax:
Practice Address - Street 1:9601 MALL RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501-8540
Practice Address - Country:US
Practice Address - Phone:304-983-6699
Practice Address - Fax:304-983-6681
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV994-D152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVSI406849Medicare ID - Type Unspecified
T49061Medicare UPIN