Provider Demographics
NPI:1689887994
Name:DR. EDDIE ALAN SMITH PLLC
Entity Type:Organization
Organization Name:DR. EDDIE ALAN SMITH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:405-372-7337
Mailing Address - Street 1:617 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4060
Mailing Address - Country:US
Mailing Address - Phone:405-372-7337
Mailing Address - Fax:
Practice Address - Street 1:617 S MAIN ST
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4060
Practice Address - Country:US
Practice Address - Phone:405-372-7337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1168152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100763810AMedicaid
OK1104828946OtherTYPE I NPI
OK5656170001Medicare NSC
OKT40653Medicare UPIN
OK100763810AMedicaid