Provider Demographics
NPI:1013134600
Name:SIMON, KAREN STONEBRAKER (OD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:STONEBRAKER
Last Name:SIMON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:690 E WARNER RD
Mailing Address - Street 2:SUITE 128
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-3054
Mailing Address - Country:US
Mailing Address - Phone:480-248-6173
Mailing Address - Fax:480-240-5972
Practice Address - Street 1:690 E WARNER RD
Practice Address - Street 2:SUITE 128
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-3054
Practice Address - Country:US
Practice Address - Phone:480-248-6173
Practice Address - Fax:480-240-5972
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ998152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist