Provider Demographics
NPI:1639401920
Name:FELICIA A SIMONIS OD
Entity Type:Organization
Organization Name:FELICIA A SIMONIS OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIMONIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:909-985-1814
Mailing Address - Street 1:155 N 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-6019
Mailing Address - Country:US
Mailing Address - Phone:909-985-1814
Mailing Address - Fax:909-985-1815
Practice Address - Street 1:155 N 2ND AVE
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-6019
Practice Address - Country:US
Practice Address - Phone:909-985-1814
Practice Address - Fax:909-985-1815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12004T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4490870001Medicare NSC