Individual provider Active NPI

David A Simonson, OD

  • Optometrist
  • Fort Lupton, CO
National Provider Identifier
1356314744
Registry record updated May 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2357 Issued in CO
Practice address
301 Denver Ave
Fort Lupton, CO 80621-1821
Phone
(303) 857-6550
Fax
(303) 857-6596
NPI assigned
Feb 8, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 19, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2357 CO Primary

Addresses

Primary practice location

301 Denver Ave
Fort Lupton, CO 80621-1821

Mailing address

301 Denver Ave
Fort Lupton, CO 80621-1821
Phone (303) 857-6550

Other identifiers 1

IdentifierTypeStateIssuer
P00743735OtherCORAILROAD MEDICARE MEMBER PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20040928000925 CO Practitioner - Optometry 2466421300 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Ohio State University - College of Optometry, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

301 Denver Ave
Fort Lupton, CO 80621-1821
Phone (303) 857-6550

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery13

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2357COMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Fort Lupton Vision Center PC Optometrist CurrentSince Jan 21, 2005 Accepting new patients

Locations

301 Denver Ave
Fort Lupton, CO 80621
Phone (303) 857-6550

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": "1139356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684454400000",
    "number": "1356314744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 DENVER AVE",
            "city": "FORT LUPTON",
            "state": "CO",
            "postal_code": "806211821",
            "telephone_number": "303-857-6550",
            "fax_number": "303-857-6596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 DENVER AVE",
            "city": "FORT LUPTON",
            "state": "CO",
            "postal_code": "806211821",
            "telephone_number": "303-857-6550",
            "fax_number": "303-857-6596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMONSON",
        "first_name": "DAVID",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-08",
        "last_updated": "2023-05-19",
        "certification_date": "2023-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CO",
            "license": "2357",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE MEMBER PTAN",
            "identifier": "P00743735",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Lupton, CO

Sources for this page

Verify at the official NPI Registry.