Provider Demographics
NPI:1225114812
Name:SIMPSON, MONICA JOY (OD)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:JOY
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 1:340 MEIJER WAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3340
Mailing Address - Country:US
Mailing Address - Phone:859-278-0055
Mailing Address - Fax:859-277-4490
Practice Address - Street 1:340 MEIJER WAY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3340
Practice Address - Country:US
Practice Address - Phone:859-278-0055
Practice Address - Fax:859-277-4490
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1575DT152W00000X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77001295Medicaid
KYU99348Medicare UPIN
KY77001295Medicaid