Provider Demographics
NPI:1760442677
Name:STEPHEN E SMITH MD PA
Entity Type:Organization
Organization Name:STEPHEN E SMITH MD PA
Other - Org Name:EYE ASSOCIATES OF FORT MYERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MEGHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LIGHTHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-939-0413
Mailing Address - Street 1:4225 EVANS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9311
Mailing Address - Country:US
Mailing Address - Phone:239-936-7685
Mailing Address - Fax:239-936-8683
Practice Address - Street 1:4225 EVANS AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-9311
Practice Address - Country:US
Practice Address - Phone:239-936-7685
Practice Address - Fax:239-936-8683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254549700Medicaid
FLK5519Medicare PIN
FL254549700Medicaid
FL4989260001Medicare NSC