Provider Demographics
NPI:1417374752
Name:PIERO A. SIMONE, M.D., P.C.
Entity Type:Organization
Organization Name:PIERO A. SIMONE, M.D., P.C.
Other - Org Name:SIMONE EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PIERO
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIMONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-558-2981
Mailing Address - Street 1:29245 RYAN RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-4284
Mailing Address - Country:US
Mailing Address - Phone:586-558-2981
Mailing Address - Fax:586-558-8838
Practice Address - Street 1:15959 HALL RD
Practice Address - Street 2:SUITE 202
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-5363
Practice Address - Country:US
Practice Address - Phone:586-558-2981
Practice Address - Fax:586-558-8838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-25
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIPS066663332H00000X
MIJV003935332H00000X
MI4901004738332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4397424Medicaid
MIOP21930Medicare PIN