Provider Demographics
NPI:1497738595
Name:SMITH, ROBERT KIRK (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:KIRK
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 1:948 N PINE HILLS RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-7212
Mailing Address - Country:US
Mailing Address - Phone:407-295-1234
Mailing Address - Fax:407-293-2867
Practice Address - Street 1:948 N PINE HILLS RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-7212
Practice Address - Country:US
Practice Address - Phone:407-295-1234
Practice Address - Fax:407-293-2867
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2900152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20666YMedicare ID - Type Unspecified
U61559Medicare UPIN