Individual provider Active NPI

Richard Kenneth Simonds, O.D.

  • Optometrist
  • Hemet, CA
National Provider Identifier
1710988027
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT9091TLG Issued in CA
Practice address
3601 W Florida Ave
Hemet, CA 92545-3514
Phone
(951) 652-3072
Fax
(951) 766-4244
NPI assigned
Aug 9, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPT9091TLG CA Primary

Addresses

Primary practice location

3601 W Florida Ave
Hemet, CA 92545-3514

Mailing address

3601 W Florida Ave
Hemet, CA 92545-3514
Phone (951) 652-3072

Other practice location 1

6755 Mira Mesa Blvd
Suite 141
San Diego, CA 92121-4392
Phone (858) 535-8282

Other practice location 2

6755 Mira Mesa Blvd
Suite 141
San Diego, CA 92121-4392
Phone (858) 535-8282

Other identifiers 1

IdentifierTypeStateIssuer
SD0090912MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPT9091TLGCAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Luxottica of America Inc. Past Accepting new patients
Tony D Pham OD Inc Optometrist PastSince Jul 1, 2008 Accepting new patients

Organizations & group practices 2

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": "1123545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1710988027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3601 W FLORIDA AVE",
            "city": "HEMET",
            "state": "CA",
            "postal_code": "925453514",
            "telephone_number": "951-652-3072",
            "fax_number": "951-766-4244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3601 W FLORIDA AVE",
            "city": "HEMET",
            "state": "CA",
            "postal_code": "925453514",
            "telephone_number": "951-652-3072",
            "fax_number": "951-766-4244"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6755 Mira Mesa Blvd",
            "address_2": "Suite 141",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921214392",
            "country_code": "US",
            "telephone_number": "858-535-8282",
            "fax_number": "858-535-0537",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6755 Mira Mesa Blvd",
            "address_2": "Suite 141",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921214392",
            "country_code": "US",
            "telephone_number": "858-535-8282",
            "fax_number": "858-535-0537",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SIMONDS",
        "first_name": "RICHARD",
        "middle_name": "KENNETH",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-09",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT9091TLG",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0090912",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hemet, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.