Provider Demographics
NPI:1174541262
Name:SIMONSON, JAMES L (OD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:L
Last Name:SIMONSON
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 1:417 CENTER ST
Mailing Address - Street 2:P.O. BOX 516
Mailing Address - City:TAFT
Mailing Address - State:CA
Mailing Address - Zip Code:93268-3510
Mailing Address - Country:US
Mailing Address - Phone:661-765-4270
Mailing Address - Fax:
Practice Address - Street 1:417 CENTER ST
Practice Address - Street 2:
Practice Address - City:TAFT
Practice Address - State:CA
Practice Address - Zip Code:93268-3510
Practice Address - Country:US
Practice Address - Phone:661-765-4270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5779152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0367790001Medicare NSC