Provider Demographics
NPI:1568844942
Name:SIMPLE VISION PARTNERS
Entity Type:Organization
Organization Name:SIMPLE VISION PARTNERS
Other - Org Name:SIMPLE VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL PARTNER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:614-226-3535
Mailing Address - Street 1:5685 BROOKFIELD SQ W
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-3708
Mailing Address - Country:US
Mailing Address - Phone:614-226-3535
Mailing Address - Fax:
Practice Address - Street 1:320 S STATE ST STE M
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-2242
Practice Address - Country:US
Practice Address - Phone:614-226-3535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-23
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty