Individual provider Active NPI

Felicia Ann Simonis, O.D.

  • Optometrist
  • Upland, CA
National Provider Identifier
1912038845
Registry record updated Nov 26, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
12004T Issued in CA
Practice address
155 N 2ND Ave
Upland, CA 91786-6019
Phone
(909) 985-1814
Fax
(909) 985-1815
NPI assigned
Mar 9, 2007
Last updated
Nov 26, 2008By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 26, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 12004T CA Primary

Addresses

Primary practice location

155 N 2ND Ave
Upland, CA 91786-6019

Mailing address

155 N 2ND Ave
Upland, CA 91786-6019
Phone (909) 985-1814

Other identifiers 1

IdentifierTypeStateIssuer
SD0120040MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20040318000945 CA Practitioner - Optometry 0749170124 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12004TCAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Fontana Optometric Group, Inc. Optometrist CurrentSince Dec 7, 2025 Accepting new patients

Locations

1095 E Arrow Hwy
Upland, CA 91786
Phone (909) 981-5399

155 N 2nd Ave
Upland, CA 91786
Phone (909) 985-1814

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1173398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1227657600000",
    "number": "1912038845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 N 2ND AVE",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917866019",
            "telephone_number": "909-985-1814",
            "fax_number": "909-985-1815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 N 2ND AVE",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917866019",
            "telephone_number": "909-985-1814",
            "fax_number": "909-985-1815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMONIS",
        "first_name": "FELICIA",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-09",
        "last_updated": "2008-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "12004T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0120040",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Upland, CA

Sources for this page

Verify at the official NPI Registry.