DR. KEITH A SIMON OD
NPI 1821069311
Optometrist in Venice, CA
About Dr. Keith A Simon Od NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DR. KEITH A SIMON OD (NPI 1821069311) is an individual optometrist in Venice, California, licensed in California (10592 TPG) and active in the NPI registry since February 2006. He is enrolled in Medicare PECOS and is a graduate of Other (1995).
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Dr. Keith A Simon Od is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignment
Medicare enrollment records show Keith Simon reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Venice, CA 90291
- Reassigned Medicare billing, California enrollment
- 147 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 90291 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Keith Simon's NPI number?
The NPI number for Keith Simon is 1821069311. It was assigned to this individual provider in the NPPES registry on February 1, 2006.
Where is Keith Simon located?
Keith Simon practices at 604 Rose Ave Venice Family Clinic/Optometry Dept., Venice, CA 90291. The listed phone number is (310) 392-8636.
What is Keith Simon's specialty?
The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.
Is Keith Simon enrolled in Medicare?
Yes. Keith Simon is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organization bills Medicare for Keith Simon's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Keith Simon reassigns Medicare benefits to Venice Family Clinic (Venice, CA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Keith Simon's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Keith Simon was last updated on February 18, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Dr. Keith A Simon, OD · NPI 1821069311
Optometrist provider in Venice, California. Individual provider, active in the CMS NPPES registry since February 1, 2006.
## Identity
- **NPI:** 1821069311 (Entity type: Individual)
- **Enumerated:** February 1, 2006
- **Primary specialty:** Optometrist · taxonomy 152W00000X
- **State license:** 10592 TPG (California)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 604 ROSE AVE, VENICE FAMILY CLINIC/OPTOMETRY DEPT., Venice, CA 90291-2767
- **Phone:** (310) 392-8636
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health
- **Bills Medicare through:** Venice Family Clinic (NPI 1669418513, Venice, CA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 1995
## Record status
- **NPPES last updated:** February 18, 2021
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Source: [NPI Profile](https://npiprofile.com/npi/1821069311) · Data from the CMS NPPES public registry.