Provider Demographics
NPI:1780664839
Name:SMITH, THOMAS E (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
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 1:707 W TIPTON ST
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-2157
Mailing Address - Country:US
Mailing Address - Phone:812-524-3937
Mailing Address - Fax:812-524-8647
Practice Address - Street 1:707 W TIPTON ST
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-2157
Practice Address - Country:US
Practice Address - Phone:812-524-3937
Practice Address - Fax:812-524-8647
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002065B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN410036773OtherRAILROAD MEDICARE
IN100140550AMedicaid
IN381920Medicare PIN
IN100140550AMedicaid