Provider Demographics
NPI:1962592543
Name:SIMONS, MICHAEL HARRY (OD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:HARRY
Last Name:SIMONS
Suffix:
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 1:726 KENSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-5720
Mailing Address - Country:US
Mailing Address - Phone:406-549-9413
Mailing Address - Fax:406-543-3410
Practice Address - Street 1:726 KENSINGTON AVE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-5720
Practice Address - Country:US
Practice Address - Phone:406-549-9413
Practice Address - Fax:406-543-4410
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT564152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT3896910001Medicare NSC
MTU25365Medicare UPIN