Provider Demographics
NPI:1720137193
Name:SIMEON, RONALD HENRY (OD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:HENRY
Last Name:SIMEON
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 1:6009 KESTREL POINT AVE
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-5022
Mailing Address - Country:US
Mailing Address - Phone:813-662-9366
Mailing Address - Fax:
Practice Address - Street 1:407 W BLOOMINGDALE AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-7401
Practice Address - Country:US
Practice Address - Phone:813-655-9710
Practice Address - Fax:813-661-0682
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC0002680152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU49616Medicare UPIN