Provider Demographics
NPI:1952410524
Name:SIMPSON, CHARLES BARRETT (OD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:BARRETT
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 1:2525 ELIZABETHTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LEITCHFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42754-9120
Mailing Address - Country:US
Mailing Address - Phone:270-259-2020
Mailing Address - Fax:270-259-5660
Practice Address - Street 1:2525 ELIZABETHTOWN RD
Practice Address - Street 2:
Practice Address - City:LEITCHFIELD
Practice Address - State:KY
Practice Address - Zip Code:42754-9120
Practice Address - Country:US
Practice Address - Phone:270-259-2020
Practice Address - Fax:270-259-5660
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1554DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000542754OtherANTHEM BCBS
KY77903896Medicaid
KY000000542753OtherANTHEM BCBS
KYP00683697OtherRAILROAD MEDICARE
KY000000542754OtherANTHEM BCBS
KY000000542753OtherANTHEM BCBS
KYP00683697OtherRAILROAD MEDICARE
KY77903896Medicaid