Provider Demographics
NPI:1487047981
Name:HERBERT J. SIMONS, MD
Entity type:Organization
Organization Name:HERBERT J. SIMONS, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:SIMONS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-807-5972
Mailing Address - Street 1:10520 WHIPPLE ST
Mailing Address - Street 2:
Mailing Address - City:TOLUCA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:91602-2838
Mailing Address - Country:US
Mailing Address - Phone:303-807-5972
Mailing Address - Fax:
Practice Address - Street 1:2650 E IMPERIAL HWY
Practice Address - Street 2:SUITE 202
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-6103
Practice Address - Country:US
Practice Address - Phone:714-524-3054
Practice Address - Fax:714-524-3094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC28351207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC28351Medicare PIN