Provider Demographics
NPI:1659407260
Name:ANDREW P SMITH, OD
Entity Type:Organization
Organization Name:ANDREW P SMITH, OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:P
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:315-539-9160
Mailing Address - Street 1:204 MAIN STREET SHOP CTR
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:NY
Mailing Address - Zip Code:13165-1454
Mailing Address - Country:US
Mailing Address - Phone:315-539-9160
Mailing Address - Fax:
Practice Address - Street 1:204 MAIN STREET SHOP CTR
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:NY
Practice Address - Zip Code:13165-1454
Practice Address - Country:US
Practice Address - Phone:315-539-9160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005146-J152W00000X, 302F00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No302F00000XManaged Care OrganizationsExclusive Provider Organization
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY101985CSOtherPREFERRED CARE
NY135462CTOtherPREFERRED CARE
NY101985CSOtherPREFERRED CARE