Provider Demographics
NPI:1780875880
Name:JOHN F SIMPSON JR PSC
Entity type:Organization
Organization Name:JOHN F SIMPSON JR PSC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:859-278-2020
Mailing Address - Street 1:340 MEIJER WAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3340
Mailing Address - Country:US
Mailing Address - Phone:859-278-0055
Mailing Address - Fax:859-277-4490
Practice Address - Street 1:340 MEIJER WAY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3340
Practice Address - Country:US
Practice Address - Phone:859-278-0055
Practice Address - Fax:859-277-4490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1045DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000049308OtherBCBS
KY77903847Medicaid
KYT54743Medicare UPIN
KY0650960001Medicare NSC