Individual provider Active NPI

Karen Stonebraker Simon, O.D.

  • Optometrist
  • Gilbert, AZ
National Provider Identifier
1013134600
Registry record updated Jul 8, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
998 Issued in AZ
Practice address
690 E Warner Rd
Suite 128
Gilbert, AZ 85296-3054
Phone
(480) 248-6173
Fax
(480) 240-5972
NPI assigned
Apr 18, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 998 AZ Primary

Addresses

Primary practice location

690 E Warner Rd
Suite 128
Gilbert, AZ 85296-3054

Mailing address

690 E Warner Rd
Suite 128
Gilbert, AZ 85296-3054
Phone (480) 248-6173

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20031210000713 AZ Practitioner - Optometry 7517863525 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern California College of Optometry, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

690 E Warner Rd
Suite 128
Gilbert, AZ 85296-3057
Phone (480) 248-6173

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
998AZMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Eyedeology Vision Center PLLC Optometrist CurrentSince Dec 15, 2013 Accepting new patients

Locations

690 E Warner Rd
Ste 128
Gilbert, AZ 85296
Phone (480) 248-6173

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1404777600000",
    "number": "1013134600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "690 E WARNER RD",
            "address_2": "SUITE 128",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852963054",
            "telephone_number": "480-248-6173",
            "fax_number": "480-240-5972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "690 E WARNER RD",
            "address_2": "SUITE 128",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852963054",
            "telephone_number": "480-248-6173",
            "fax_number": "480-240-5972"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMON",
        "first_name": "KAREN",
        "middle_name": "STONEBRAKER",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-18",
        "last_updated": "2014-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AZ",
            "license": "998",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gilbert, AZ

Sources for this page

Verify at the official NPI Registry.