Provider Demographics
NPI:1215029350
Name:SMITH, DANIEL C (OD)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:C
Last Name:SMITH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1691 N US 23
Mailing Address - Street 2:SUITE 2
Mailing Address - City:E TAWAS
Mailing Address - State:MI
Mailing Address - Zip Code:48730
Mailing Address - Country:US
Mailing Address - Phone:989-362-9546
Mailing Address - Fax:989-362-9567
Practice Address - Street 1:1691 N US 23
Practice Address - Street 2:SUITE 2
Practice Address - City:E TAWAS
Practice Address - State:MI
Practice Address - Zip Code:48730
Practice Address - Country:US
Practice Address - Phone:989-362-9546
Practice Address - Fax:989-362-9567
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003153152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI410046393OtherRAILROAD MEDICARE
MIOM89210001OtherBCBSM MEDICARE ADVANTAGE
MI900C510060OtherBLUE CROSS BLUE SHIELD
T32908Medicare UPIN
MI410046393OtherRAILROAD MEDICARE
MIOM89210001OtherBCBSM MEDICARE ADVANTAGE
MIM89210001Medicare PIN