Provider Demographics
NPI:1184946519
Name:BARRY M. SIMON, O.D., P.A.
Entity type:Organization
Organization Name:BARRY M. SIMON, O.D., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:MARC
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:954-360-0033
Mailing Address - Street 1:3788 W HILLSBORO BLVD
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-9412
Mailing Address - Country:US
Mailing Address - Phone:954-360-0033
Mailing Address - Fax:
Practice Address - Street 1:3788 W HILLSBORO BLVD
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-9412
Practice Address - Country:US
Practice Address - Phone:954-360-0033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-26
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC002327152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1079100001Medicare NSC
FLDN758AMedicare PIN