Provider Demographics
NPI:1205960242
Name:LYEW, SIMONE ANNA (OD)
Entity type:Individual
Prefix:DR
First Name:SIMONE
Middle Name:ANNA
Last Name:LYEW
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3857 MATTIE PL
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-3117
Mailing Address - Country:US
Mailing Address - Phone:951-785-8920
Mailing Address - Fax:
Practice Address - Street 1:5200 VAN BUREN BLVD
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-2544
Practice Address - Country:US
Practice Address - Phone:951-689-4609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11330T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist