Provider Demographics
NPI:1336136001
Name:SIMONSON, HEATHER M (OD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:M
Last Name:SIMONSON
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 1:215 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:EATON
Mailing Address - State:CO
Mailing Address - Zip Code:80615-3428
Mailing Address - Country:US
Mailing Address - Phone:970-454-3387
Mailing Address - Fax:970-454-3380
Practice Address - Street 1:215 ELM AVE
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:CO
Practice Address - Zip Code:80615-3428
Practice Address - Country:US
Practice Address - Phone:970-454-3387
Practice Address - Fax:970-454-3380
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT1014152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08910143Medicaid
CO0294540001OtherDMERC
UO6361Medicare UPIN
CO08910143Medicaid