Provider Demographics
NPI:1356314744
Name:SIMONSON, DAVID A (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:SIMONSON
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 1:301 DENVER AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LUPTON
Mailing Address - State:CO
Mailing Address - Zip Code:80621-1821
Mailing Address - Country:US
Mailing Address - Phone:303-857-6550
Mailing Address - Fax:303-857-6596
Practice Address - Street 1:301 DENVER AVE
Practice Address - Street 2:
Practice Address - City:FORT LUPTON
Practice Address - State:CO
Practice Address - Zip Code:80621-1821
Practice Address - Country:US
Practice Address - Phone:303-857-6550
Practice Address - Fax:303-857-6596
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2357152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP00743735OtherRAILROAD MEDICARE MEMBER PTAN
COC801274Medicare PIN
V01360Medicare UPIN
COP00743735OtherRAILROAD MEDICARE MEMBER PTAN