Provider Demographics
NPI:1316039043
Name:SIMPSON, MICHAEL GUY (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GUY
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SUPER CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16830
Mailing Address - Country:US
Mailing Address - Phone:814-765-5110
Mailing Address - Fax:
Practice Address - Street 1:100 SUPER CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:PA
Practice Address - Zip Code:16830
Practice Address - Country:US
Practice Address - Phone:814-765-5110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE007498T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U48796Medicare UPIN