Provider Demographics
NPI:1497945430
Name:SIMON, ALLEN BRUCE (OD)
Entity Type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:BRUCE
Last Name:SIMON
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 1:4709 GOLF RD
Mailing Address - Street 2:TOWER 2 12TH FL MYERS WYSE CENTER FOR THE EYE
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076
Mailing Address - Country:US
Mailing Address - Phone:847-328-2020
Mailing Address - Fax:847-328-0523
Practice Address - Street 1:4709 GOLF RD
Practice Address - Street 2:TOWER 2 12TH FL MYERS WYSE CENTER FOR THE EYE
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076
Practice Address - Country:US
Practice Address - Phone:847-328-2020
Practice Address - Fax:847-328-0523
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management