Provider Demographics
NPI:1003958067
Name:SMITH, TOD W (OD)
Entity Type:Individual
Prefix:DR
First Name:TOD
Middle Name:W
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 1:232 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:RIFLE
Mailing Address - State:CO
Mailing Address - Zip Code:81650-2320
Mailing Address - Country:US
Mailing Address - Phone:970-625-1921
Mailing Address - Fax:970-625-1928
Practice Address - Street 1:232 E 3RD ST
Practice Address - Street 2:
Practice Address - City:RIFLE
Practice Address - State:CO
Practice Address - Zip Code:81650-2320
Practice Address - Country:US
Practice Address - Phone:970-625-1921
Practice Address - Fax:970-625-1928
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1374152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0859980001Medicare NSC
COC43473Medicare PIN
COU45194Medicare UPIN