Provider Demographics
NPI:1376599696
Name:SIMPSON EYE ASSOCIATES LTD
Entity Type:Organization
Organization Name:SIMPSON EYE ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:MELCHIONNA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:847-426-0227
Mailing Address - Street 1:650 SPRING HILL RING RD
Mailing Address - Street 2:SUITE 2020
Mailing Address - City:WEST DUNDEE
Mailing Address - State:IL
Mailing Address - Zip Code:60118-1296
Mailing Address - Country:US
Mailing Address - Phone:847-426-0227
Mailing Address - Fax:847-426-0299
Practice Address - Street 1:11620 ALGONQUIN RD
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-7175
Practice Address - Country:US
Practice Address - Phone:847-669-5600
Practice Address - Fax:847-426-0299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL919850Medicare PIN