Provider Demographics
NPI:1952675605
Name:CHRIS SIMOPOULOS LLC
Entity Type:Organization
Organization Name:CHRIS SIMOPOULOS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMOPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:602-790-4610
Mailing Address - Street 1:7575 W LOWER BUCKEYE RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85043-3450
Mailing Address - Country:US
Mailing Address - Phone:602-790-4610
Mailing Address - Fax:
Practice Address - Street 1:7575 W LOWER BUCKEYE RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85043-3450
Practice Address - Country:US
Practice Address - Phone:623-907-5952
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-28
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZL-1730351-7305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service