Provider Demographics
NPI:1508001751
Name:THOMAS-SMITH, OTTIE M (BCO, CCA)
Entity Type:Individual
Prefix:
First Name:OTTIE
Middle Name:M
Last Name:THOMAS-SMITH
Suffix:
Gender:F
Credentials:BCO, CCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 MOOSEHEAD TRL
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:ME
Mailing Address - Zip Code:04921-3314
Mailing Address - Country:US
Mailing Address - Phone:207-722-3462
Mailing Address - Fax:207-722-3320
Practice Address - Street 1:780 BOYLSTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02199-7820
Practice Address - Country:US
Practice Address - Phone:617-750-6273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-02
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularist