Provider Demographics
NPI:1912922378
Name:SIMPSON, GREGORY JON (OD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:JON
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 1:1800 HWAY 95
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-6803
Mailing Address - Country:US
Mailing Address - Phone:928-763-4333
Mailing Address - Fax:928-763-3073
Practice Address - Street 1:1800 HWAY 95
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442
Practice Address - Country:US
Practice Address - Phone:928-763-8443
Practice Address - Fax:928-763-3073
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1542152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist