Provider Demographics
NPI:1821002916
Name:SMITH, MARNIE CATHERINE (OD)
Entity Type:Individual
Prefix:
First Name:MARNIE
Middle Name:CATHERINE
Last Name:SMITH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 COLT HWY
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2547
Mailing Address - Country:US
Mailing Address - Phone:860-409-0449
Mailing Address - Fax:860-409-0551
Practice Address - Street 1:366 COLT HWY
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2547
Practice Address - Country:US
Practice Address - Phone:860-409-0449
Practice Address - Fax:860-409-0551
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT02659152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004249589Medicaid
CTP3576498OtherOXFORD
CT026590OtherCONNECTICARE
CT1566708OtherCIGNA
CT3815284OtherAETNA
CT090002659CT01OtherANTHEM BLUE CROSS
CT2V6349OtherHEALTHNET
CT090002659CT01OtherBLUE CARE FAMILY PLAN
CT004249589Medicaid
CT090002659CT01OtherANTHEM BLUE CROSS