Provider Demographics
NPI:1609973163
Name:SMITH, DENNIS E (OD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
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 1:10601 RANCH ROAD 2222
Mailing Address - Street 2:STE. G
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78730-1134
Mailing Address - Country:US
Mailing Address - Phone:512-343-2020
Mailing Address - Fax:
Practice Address - Street 1:10601 RANCH ROAD 2222
Practice Address - Street 2:STE. G
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78730-1134
Practice Address - Country:US
Practice Address - Phone:512-343-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6051T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXV99619Medicare UPIN
TX610401Medicare ID - Type Unspecified