Provider Demographics
NPI:1437357746
Name:SIMONTON, LAURA RACHELE (OD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:RACHELE
Last Name:SIMONTON
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 1:480 SHELBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15239-3614
Mailing Address - Country:US
Mailing Address - Phone:724-513-1110
Mailing Address - Fax:
Practice Address - Street 1:2510 GREENGATE CENTRE CIR
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-1292
Practice Address - Country:US
Practice Address - Phone:724-834-7662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-08
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEGOO1910152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA135410U47Medicare PIN