Provider Demographics
NPI:1629056726
Name:SIMPSON, STEPHEN CHADWICK (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:CHADWICK
Last Name:SIMPSON
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 1:51ST MEDICAL GROUP
Mailing Address - Street 2:BLDG 777 UNIT 2060
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96278
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:51ST MEDICAL GROUP
Practice Address - Street 2:BLDG 777 UNIT 2060
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96278
Practice Address - Country:US
Practice Address - Phone:000-784-2151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2428152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist