Provider Demographics
NPI:1225125644
Name:SUE C. SIMPSON
Entity Type:Organization
Organization Name:SUE C. SIMPSON
Other - Org Name:EYES OF TEXAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:CAMPBELL
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:979-779-9000
Mailing Address - Street 1:2320 E VILLA MARIA RD
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2549
Mailing Address - Country:US
Mailing Address - Phone:979-779-9000
Mailing Address - Fax:979-775-2020
Practice Address - Street 1:2320 E VILLA MARIA RD
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2549
Practice Address - Country:US
Practice Address - Phone:979-779-9000
Practice Address - Fax:979-775-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3095TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0312080001Medicare NSC