Provider Demographics
NPI:1912038845
Name:SIMONIS, FELICIA ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:FELICIA
Middle Name:ANN
Last Name:SIMONIS
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 1:155 N 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-6019
Mailing Address - Country:US
Mailing Address - Phone:909-985-1814
Mailing Address - Fax:909-985-1815
Practice Address - Street 1:155 N 2ND AVE
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-6019
Practice Address - Country:US
Practice Address - Phone:909-985-1814
Practice Address - Fax:909-985-1815
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12004T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0120040Medicaid
CAU72612Medicare UPIN
CASD0120040Medicaid
4490870001Medicare NSC