Provider Demographics
NPI:1356475438
Name:TODD R. SMITH
Entity Type:Organization
Organization Name:TODD R. SMITH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:RIPLEY
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:940-552-2204
Mailing Address - Street 1:1730 HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:TX
Mailing Address - Zip Code:76384-7715
Mailing Address - Country:US
Mailing Address - Phone:940-552-2204
Mailing Address - Fax:940-552-2204
Practice Address - Street 1:2030 TEXAS ST
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:TX
Practice Address - Zip Code:76384-4450
Practice Address - Country:US
Practice Address - Phone:940-552-2204
Practice Address - Fax:940-552-2210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4713T332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00E34ZOtherBCBS
TX113303501Medicaid
TX113303501Medicaid
TX00130EMedicare PIN
TX1219280001Medicare NSC