Provider Demographics
NPI:1952475584
Name:SIMSARIAN, RICHARD Z (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:Z
Last Name:SIMSARIAN
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 1:1719 NORIEGA ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-4307
Mailing Address - Country:US
Mailing Address - Phone:415-664-3633
Mailing Address - Fax:415-664-3669
Practice Address - Street 1:1719 NORIEGA ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-4307
Practice Address - Country:US
Practice Address - Phone:415-664-3633
Practice Address - Fax:415-664-3669
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3863T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0038630Medicaid
CATO9495Medicare UPIN
CASD0038630Medicaid
CA0227970001Medicare NSC