Provider Demographics
NPI:1821413162
Name:SAFIR, SIMON GABRIEL
Entity Type:Individual
Prefix:
First Name:SIMON
Middle Name:GABRIEL
Last Name:SAFIR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2403 S STEMMONS FWY
Mailing Address - Street 2:SUITE 113
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-8976
Mailing Address - Country:US
Mailing Address - Phone:972-316-1113
Mailing Address - Fax:
Practice Address - Street 1:2403 S STEMMONS FWY
Practice Address - Street 2:SUITE 113
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-8976
Practice Address - Country:US
Practice Address - Phone:972-316-1113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-24
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
156F00000X
TXDR3722156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist