Provider Demographics
NPI:1427193200
Name:SMITH, SCOTT MONSON (OD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:MONSON
Last Name:SMITH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3251 99TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-1803
Mailing Address - Country:US
Mailing Address - Phone:425-455-8319
Mailing Address - Fax:
Practice Address - Street 1:3923 FACTORIA SQUARE MALL SE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-1264
Practice Address - Country:US
Practice Address - Phone:425-644-7702
Practice Address - Fax:425-643-2761
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2013-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00003629152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAUBI602079805OtherBELLEVUEUBI#
WAU50385Medicare UPIN
WA121091Medicare PIN