Provider Demographics
NPI:1639232762
Name:SMITH, RODNEY J (OD)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:J
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 1:1104 NE 2ND TER
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-2655
Mailing Address - Country:US
Mailing Address - Phone:239-573-4742
Mailing Address - Fax:
Practice Address - Street 1:1890 NE PINE ISLAND RD
Practice Address - Street 2:DOCTOR SMITH EYE CARE (INSIDE TARGET OPTICAL)
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-1733
Practice Address - Country:US
Practice Address - Phone:239-573-4742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003980152W00000X
FLOPC3175152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIC58997Medicare UPIN