Provider Demographics
NPI:1225165541
Name:SIMONS, LAWRENCE GLENN (OD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:GLENN
Last Name:SIMONS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:2035 WESTWOOD BLVD
Mailing Address - Street 2:# 101
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6332
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2035 WESTWOOD BLVD
Practice Address - Street 2:# 101
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6332
Practice Address - Country:US
Practice Address - Phone:310-234-0202
Practice Address - Fax:310-474-3423
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7352T152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT70191Medicare UPIN
CAT70191Medicare ID - Type Unspecified