Provider Demographics
NPI:1619963733
Name:SIMPSON, STEPHEN N (OD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:N
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 1:2417 W FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47712-5564
Mailing Address - Country:US
Mailing Address - Phone:812-423-5000
Mailing Address - Fax:812-423-6838
Practice Address - Street 1:2417 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47712-5564
Practice Address - Country:US
Practice Address - Phone:812-423-5000
Practice Address - Fax:812-423-6838
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002839A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN24048OtherSPECTERA
IN1177350001OtherDMERC REGION B
IN180567OtherHIGHMARK CLARITY VISION
IN200118870AMedicaid
IN000000092506OtherANTHEM
IN410033865OtherRAILROAD MEDICARE
INU63252Medicare UPIN
IN200118870AMedicaid