Basic Information
| Provider Information | |||||||||
| NPI: | 1790785285 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIMON | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 518 WEST AVE | ||||||||
| Address2: | |||||||||
| City: | TALLMADGE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442782117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306309699 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3330 KENT RD | ||||||||
| Address2: | |||||||||
| City: | STOW | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442244537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306888811 | ||||||||
| FaxNumber: | 3302963231 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2005 | ||||||||
| LastUpdateDate: | 06/30/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 5416 | OH | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.