Provider Demographics
NPI:1114150968
Name:SIMPSON & BIGHAM OD PARTNERSHIP
Entity Type:Organization
Organization Name:SIMPSON & BIGHAM OD PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:GORMAN-MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-423-5000
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-27
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002839152W00000X
IN18003226152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200118870Medicaid
IN200441230Medicaid
IN200441230Medicaid
IN206550Medicare PIN
IN6164020001Medicare NSC