Provider Demographics
NPI:1508914680
Name:SMITH, LINDLEY THEODORE (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDLEY
Middle Name:THEODORE
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14002 BAYPORT LANDING TER
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-2038
Mailing Address - Country:US
Mailing Address - Phone:804-739-7821
Mailing Address - Fax:
Practice Address - Street 1:1510 N 28TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-5311
Practice Address - Country:US
Practice Address - Phone:804-225-7286
Practice Address - Fax:804-222-5836
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101025383207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA180000939Medicare ID - Type Unspecified