Provider Demographics
NPI:1548451545
Name:PATRICIA H. SIMPSON, O.D., LTD.
Entity type:Organization
Organization Name:PATRICIA H. SIMPSON, O.D., LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/PRESIDENT OF CORPORATIO
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:HELEN
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:815-838-8069
Mailing Address - Street 1:123 E 9TH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-3690
Mailing Address - Country:US
Mailing Address - Phone:815-838-8069
Mailing Address - Fax:815-838-8088
Practice Address - Street 1:123 E 9TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-3690
Practice Address - Country:US
Practice Address - Phone:815-838-8069
Practice Address - Fax:815-838-8088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL09932280OtherBC/BS OF IL
IL09932280OtherBC/BS OF IL
ILP00217779Medicare PIN
IL5395310001Medicare NSC
IL211027Medicare PIN