Provider Demographics
NPI:1053334128
Name:SMITH, ALLAN J (OD)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:J
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 1:3027 ENGLISH ROW AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-5105
Mailing Address - Country:US
Mailing Address - Phone:630-922-2661
Mailing Address - Fax:
Practice Address - Street 1:3027 ENGLISH ROW AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-5105
Practice Address - Country:US
Practice Address - Phone:630-922-2661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008182152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU10101Medicare ID - Type Unspecified
ILU10101Medicare UPIN