Katie Lee Simon, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

4901004118 Issued in MI

Practice address

6483 S Westnedge Ave
Portage, MI 49002-3542

Phone

(269) 324-4242

Fax

(269) 324-6145

NPI assigned

Dec 29, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Portage Family Vision Care, PC

  • Optometrist
  • Portage, MI
  • NPI 1669711438
  Medicare reassignment NPD Authorized official
• Eyeglass Acquisitions, Inc.

  • Eyewear Supplier
  • Big Rapids, MI
  • NPI 1629130885
  NPD (past)
• Steinhoff Optical, LLC

  • Eyewear Supplier
  • Saint Joseph, MI
  • NPI 1063524171

  Optometrist

  NPD (past)

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

{
    "created_epoch": "1135814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646265600000",
    "number": "1366429581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6483 S WESTNEDGE AVE",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490023542",
            "telephone_number": "269-324-4242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6483 S WESTNEDGE AVE",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490023542",
            "telephone_number": "269-324-4242",
            "fax_number": "269-324-6145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMON",
        "first_name": "KATIE",
        "middle_name": "LEE",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-29",
        "last_updated": "2022-03-03",
        "certification_date": "2022-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901004118",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4551220",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shrieeji Inc
• Patricia Shull-Blood, LLP
• Kimberly Sieklucki
• Haley Rose Sikkenga, PT, DPT
• Karolina Silinyte
• James H Simonds, DPM
• Alonzo Sims-Ampey-Littlejohn
• Laurie Sindelar
• Lashala Sivley
• Jaroslaw P Siwik, MD

• Optometrist in Portage, MI
• Providers in Portage, MI by specialty
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.