Provider Demographics
NPI:1407968605
Name:SMYTH, JEANETTE ROBERTSON (OD)
Entity Type:Individual
Prefix:DR
First Name:JEANETTE
Middle Name:ROBERTSON
Last Name:SMYTH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11343 AMBER CT
Mailing Address - Street 2:
Mailing Address - City:FREELAND
Mailing Address - State:MI
Mailing Address - Zip Code:48623-8441
Mailing Address - Country:US
Mailing Address - Phone:989-695-6403
Mailing Address - Fax:989-835-6919
Practice Address - Street 1:910 JOE MANN BLVD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48642-8903
Practice Address - Country:US
Practice Address - Phone:989-835-6756
Practice Address - Fax:989-835-6919
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004133152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist