Provider Demographics
NPI:1649244633
Name:SIMPSON, SUE C (OD)
Entity Type:Individual
Prefix:DR
First Name:SUE
Middle Name:C
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 E VILLA MARIA RD
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2549
Mailing Address - Country:US
Mailing Address - Phone:979-778-3927
Mailing Address - Fax:979-985-3888
Practice Address - Street 1:2320 E VILLA MARIA RD
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2549
Practice Address - Country:US
Practice Address - Phone:979-778-3927
Practice Address - Fax:979-985-3888
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3095TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0312080001OtherMEDICARE DME
TX019546301Medicaid
TX019546301Medicaid
0312080001OtherMEDICARE DME