Provider Demographics
NPI:1689160350
Name:SIMEUS, ANGELINE (OD)
Entity Type:Individual
Prefix:
First Name:ANGELINE
Middle Name:
Last Name:SIMEUS
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 1:11058 GRANDE PINES CIR APT 823
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32821-9333
Mailing Address - Country:US
Mailing Address - Phone:813-355-9543
Mailing Address - Fax:
Practice Address - Street 1:215 1ST ST N STE 100
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4507
Practice Address - Country:US
Practice Address - Phone:863-299-8908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-06
Last Update Date:2020-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3519-35152W00000X
FLOPC5739152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist