Provider Demographics
NPI:1598880890
Name:SMITH, JAMES E (OD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:E
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:PO BOX 375
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:OH
Mailing Address - Zip Code:44857-0375
Mailing Address - Country:US
Mailing Address - Phone:419-668-4183
Mailing Address - Fax:419-668-4183
Practice Address - Street 1:100 WHITTLESEY AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-1424
Practice Address - Country:US
Practice Address - Phone:419-668-4183
Practice Address - Fax:419-668-4183
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2965T659152W00000X
MI4901002342152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHT47070Medicare UPIN