Individual
KATIE LEE SIMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
6483 S WESTNEDGE AVE, PORTAGE, MI 49002-3542
(269) 324-4242
(269) 324-6145
Mailing address
6483 S WESTNEDGE AVE, PORTAGE, MI 49002-3542
(269) 324-4242
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901004118
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4551220
—
MI
Enumeration date
12/29/2005
Last updated
03/03/2022
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