Provider Demographics
NPI:1881744134
Name:SIMPSON, RICHARD YOUNG (OD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:YOUNG
Last Name:SIMPSON
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 1:1216 BURDEN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:AVERILL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12018-4816
Mailing Address - Country:US
Mailing Address - Phone:518-250-2173
Mailing Address - Fax:518-869-1871
Practice Address - Street 1:1 CROSSGATES MALL RD
Practice Address - Street 2:LENSCRAFTERS #0722
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-5368
Practice Address - Country:US
Practice Address - Phone:518-869-1828
Practice Address - Fax:518-869-1871
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT004715152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU36119Medicare UPIN
NYCC8834Medicare ID - Type Unspecified