Provider Demographics
NPI:1710988027
Name:SIMONDS, RICHARD KENNETH (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:KENNETH
Last Name:SIMONDS
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 1:3601 W FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92545-3514
Mailing Address - Country:US
Mailing Address - Phone:951-652-3072
Mailing Address - Fax:951-766-4244
Practice Address - Street 1:3601 W FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92545-3514
Practice Address - Country:US
Practice Address - Phone:951-652-3072
Practice Address - Fax:951-766-4244
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT9091TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0090912Medicaid
CAU51373Medicare UPIN
CAOP9091BMedicare ID - Type Unspecified