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Individual

KEVIN MICHAEL SIMMONS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
O.D.

Contact information

Practice address
14645 BEL RED RD, BUILDING E, STE 102, BELLEVUE, WA 98007-3929
(425) 432-6056
Mailing address
2180 TROOP DR, APT D104, SARTELL, MN 56377-4563
(320) 258-3915
(320) 258-3917

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
MN3454
MN
152WP0200X
Pediatric Optometrist
MN3454
MN
152WV0400X
Vision Therapy Optometrist
MN3454
MN

Other

Enumeration date
07/20/2012
Last updated
05/09/2016
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