Provider Demographics
NPI:1467501833
Name:SIMEON, DIANA LEE (OD)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:LEE
Last Name:SIMEON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:LEE
Other - Last Name:DAL SANTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:407 W BLOOMINGDALE AVE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-7401
Mailing Address - Country:US
Mailing Address - Phone:813-655-9710
Mailing Address - Fax:
Practice Address - Street 1:407 W BLOOMINGDALE AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-7401
Practice Address - Country:US
Practice Address - Phone:813-655-9710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC0002917152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU61758Medicare UPIN