Provider Demographics
NPI:1205247905
Name:SIMGON VISION, INC
Entity type:Organization
Organization Name:SIMGON VISION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VESNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-592-9887
Mailing Address - Street 1:4612 W DIVERSEY AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60639-1806
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4612 W DIVERSEY AVE
Practice Address - Street 2:SUITE D
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639-1806
Practice Address - Country:US
Practice Address - Phone:773-592-9887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty