Provider Demographics
NPI:1841380573
Name:SIMONTON, RALPH W III (OD)
Entity type:Individual
Prefix:MR
First Name:RALPH
Middle Name:W
Last Name:SIMONTON
Suffix:III
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 1:2823 HIGHWAY 31 W SOUTH
Mailing Address - Street 2:
Mailing Address - City:WHITE HOUSE
Mailing Address - State:TN
Mailing Address - Zip Code:37188
Mailing Address - Country:US
Mailing Address - Phone:615-672-4683
Mailing Address - Fax:615-672-4643
Practice Address - Street 1:2823 HIGHWAY 31 W. SOUTH
Practice Address - Street 2:
Practice Address - City:WHITE HOUSE
Practice Address - State:TN
Practice Address - Zip Code:37188
Practice Address - Country:US
Practice Address - Phone:615-672-4683
Practice Address - Fax:615-672-4643
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODT759152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0993660001Medicare NSC
TNU23770Medicare UPIN
TN3594618Medicare PIN