Provider Demographics
NPI:1437138492
Name:SMITH, JAMES PRESTON (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:PRESTON
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 1:138 W HOUSTON
Mailing Address - Street 2:
Mailing Address - City:SELMER
Mailing Address - State:TN
Mailing Address - Zip Code:38375
Mailing Address - Country:US
Mailing Address - Phone:731-645-7255
Mailing Address - Fax:731-645-8047
Practice Address - Street 1:138 W HOUSTON
Practice Address - Street 2:
Practice Address - City:SELMER
Practice Address - State:TN
Practice Address - Zip Code:38375
Practice Address - Country:US
Practice Address - Phone:731-645-7255
Practice Address - Fax:731-645-8047
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD000457152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3518138Medicaid
TN410030549OtherRAILROAD MEDICARE
TN3518138Medicaid
TN3518139Medicare ID - Type Unspecified