Provider Demographics
NPI:1407027709
Name:L DOUGLAS SMITH
Entity Type:Organization
Organization Name:L DOUGLAS SMITH
Other - Org Name:THE EYECENTER OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-445-5884
Mailing Address - Street 1:10 VISION LN
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-4607
Mailing Address - Country:US
Mailing Address - Phone:601-445-5884
Mailing Address - Fax:
Practice Address - Street 1:10 VISION LN
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-4607
Practice Address - Country:US
Practice Address - Phone:601-445-5884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0591140001Medicare NSC