Provider Demographics
NPI:1649274366
Name:SIMPSON, PATRICIA HELEN (O D)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:HELEN
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 OLD GALLOWS RD # SUIE520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3990
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:20 E NORTH ST
Practice Address - Street 2:
Practice Address - City:COAL CITY
Practice Address - State:IL
Practice Address - Zip Code:60416-1087
Practice Address - Country:US
Practice Address - Phone:815-634-4825
Practice Address - Fax:815-634-4938
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2021-04-13
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-20
Provider Licenses
StateLicense IDTaxonomies
IL046007569152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046007569Medicaid
IL09932280OtherBCBS OF IL
ILP00217779Medicare PIN
ILT35518Medicare UPIN
IL09932280OtherBCBS OF IL