Provider Demographics
NPI:1598278541
Name:SMAJKAN, ELDIN (OD)
Entity Type:Individual
Prefix:DR
First Name:ELDIN
Middle Name:
Last Name:SMAJKAN
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 1:3000 FORD STREET EXT
Mailing Address - Street 2:
Mailing Address - City:OGDENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13669-4480
Mailing Address - Country:US
Mailing Address - Phone:315-394-7902
Mailing Address - Fax:
Practice Address - Street 1:3000 FORD STREET EXT
Practice Address - Street 2:
Practice Address - City:OGDENSBURG
Practice Address - State:NY
Practice Address - Zip Code:13669-4480
Practice Address - Country:US
Practice Address - Phone:315-394-7902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-13
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008706152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist