Provider Demographics
NPI:1851348601
Name:SIMPSON EYE ASSOCIATES LTD
Entity Type:Organization
Organization Name:SIMPSON EYE ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:MELCHIONNA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:847-426-0227
Mailing Address - Street 1:650 SPRINGHILL RING RD
Mailing Address - Street 2:SUITE #2020
Mailing Address - City:WEST DUNDEE
Mailing Address - State:IL
Mailing Address - Zip Code:60118-1296
Mailing Address - Country:US
Mailing Address - Phone:847-426-0227
Mailing Address - Fax:847-426-0299
Practice Address - Street 1:730 E TERRA COTTA AVE
Practice Address - Street 2:SUITE 2B
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-3615
Practice Address - Country:US
Practice Address - Phone:815-455-0212
Practice Address - Fax:815-455-4903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL919850Medicare ID - Type Unspecified
IL0963780001Medicare NSC