Provider Demographics
NPI:1225044142
Name:SIMPSON, ELIZABETH ANNE (OD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANNE
Last Name:SIMPSON
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 1:1131 W 6TH ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-1121
Mailing Address - Country:US
Mailing Address - Phone:909-986-0918
Mailing Address - Fax:909-984-4918
Practice Address - Street 1:1131 W 6TH ST
Practice Address - Street 2:SUITE 150
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-1121
Practice Address - Country:US
Practice Address - Phone:909-986-0918
Practice Address - Fax:909-984-4918
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6806152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0068060Medicaid
CASD0068060Medicaid
CAT10414Medicare UPIN