Provider Demographics
NPI:1316035876
Name:SMITH, CLETE LYLE (OD)
Entity Type:Individual
Prefix:MR
First Name:CLETE
Middle Name:LYLE
Last Name:SMITH
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:1 CHISHOLM TRL STE 2100
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-5002
Mailing Address - Country:US
Mailing Address - Phone:512-255-9995
Mailing Address - Fax:512-255-9997
Practice Address - Street 1:1 CHISHOLM TRL STE 2100
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-5002
Practice Address - Country:US
Practice Address - Phone:512-255-9995
Practice Address - Fax:512-255-9997
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX3220T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT15951Medicare UPIN