Provider Demographics
NPI:1578533279
Name:SMITH, PERRY LEE II (OD)
Entity Type:Individual
Prefix:
First Name:PERRY
Middle Name:LEE
Last Name:SMITH
Suffix:II
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 1:2006 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-3308
Mailing Address - Country:US
Mailing Address - Phone:281-485-5591
Mailing Address - Fax:
Practice Address - Street 1:2006 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-3308
Practice Address - Country:US
Practice Address - Phone:281-485-5591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4149TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U12663Medicare UPIN
OOOE22NMedicare ID - Type Unspecified