Provider Demographics
NPI:1023003753
Name:SMITH, TODD R (OD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:R
Last Name:SMITH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8877 W UNION HILLS DR
Mailing Address - Street 2:STE 460
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-3008
Mailing Address - Country:US
Mailing Address - Phone:623-256-0400
Mailing Address - Fax:623-376-6800
Practice Address - Street 1:8877 W UNION HILLS DR
Practice Address - Street 2:STE 460
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-3008
Practice Address - Country:US
Practice Address - Phone:623-256-0400
Practice Address - Fax:623-376-6800
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1301152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ105874Medicare PIN
AZU96782Medicare UPIN