Provider Demographics
NPI:1003917360
Name:SMITH, OSCAR A (OD)
Entity Type:Individual
Prefix:DR
First Name:OSCAR
Middle Name:A
Last Name:SMITH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 548
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MS
Mailing Address - Zip Code:39429-0548
Mailing Address - Country:US
Mailing Address - Phone:601-736-5396
Mailing Address - Fax:601-736-0182
Practice Address - Street 1:317 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MS
Practice Address - Zip Code:39429
Practice Address - Country:US
Practice Address - Phone:601-736-5396
Practice Address - Fax:601-736-0182
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS465152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00087835Medicaid
MS2230037OtherUNITED HEALTHCARE
MS2230037OtherUNITED HEALTHCARE
MS00087835Medicaid