Provider Demographics
NPI:1053553719
Name:SIMPSON, CLINT DOUGLAS (MD)
Entity type:Individual
Prefix:DR
First Name:CLINT
Middle Name:DOUGLAS
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:850 W NORTH ST STE 104
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-3196
Mailing Address - Country:US
Mailing Address - Phone:877-852-8463
Mailing Address - Fax:517-817-0144
Practice Address - Street 1:1515 LAKE LANSING RD STE H
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3752
Practice Address - Country:US
Practice Address - Phone:517-487-6511
Practice Address - Fax:517-487-3415
Is Sole Proprietor?:No
Enumeration Date:2009-03-27
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
MI4301094332207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program