Provider Demographics
NPI:1174690705
Name:SIMSHAUSER, INGRID (OD)
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:
Last Name:SIMSHAUSER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6365 COLLINS AVE
Mailing Address - Street 2:#4408
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33141-9620
Mailing Address - Country:US
Mailing Address - Phone:305-450-7273
Mailing Address - Fax:
Practice Address - Street 1:2750 W 68TH ST
Practice Address - Street 2:#115
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5446
Practice Address - Country:US
Practice Address - Phone:305-819-3937
Practice Address - Fax:305-819-0816
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2768152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20650Medicare ID - Type UnspecifiedMEDICARE NUMBER