Basic Information
| Provider Information | |||||||||
| NPI: | 1689160350 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIMEUS | ||||||||
| FirstName: | ANGELINE | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11058 GRANDE PINES CIR APT 823 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328219333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8133559543 | ||||||||
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| Practice Location | |||||||||
| Address1: | 215 1ST ST N STE 100 | ||||||||
| Address2: | |||||||||
| City: | WINTER HAVEN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338814507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8632998908 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2018 | ||||||||
| LastUpdateDate: | 07/04/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 3519-35 | WI | N | Eye and Vision Services Providers | Optometrist | 152W00000X | OPC5739 | FL | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.