Provider Demographics
NPI:1477613024
Name:ZMYSLINSKI, SIMON RONALD (OD)
Entity Type:Individual
Prefix:DR
First Name:SIMON
Middle Name:RONALD
Last Name:ZMYSLINSKI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9617 N METRO PKWY W
Mailing Address - Street 2:1000
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-1400
Mailing Address - Country:US
Mailing Address - Phone:602-678-4395
Mailing Address - Fax:602-678-4396
Practice Address - Street 1:9617 N METRO PKWY W
Practice Address - Street 2:1000
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-1400
Practice Address - Country:US
Practice Address - Phone:602-678-4395
Practice Address - Fax:602-678-4396
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ1051152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist