Provider Demographics
NPI:1851375018
Name:SMYTH, DUANE THOMAS (OD)
Entity Type:Individual
Prefix:DR
First Name:DUANE
Middle Name:THOMAS
Last Name:SMYTH
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 1:872 LOVINGSTON DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15216-1726
Mailing Address - Country:US
Mailing Address - Phone:412-341-7062
Mailing Address - Fax:412-341-7062
Practice Address - Street 1:1221 E CARSON ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15203-1228
Practice Address - Country:US
Practice Address - Phone:412-431-3139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG826152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016938110001Medicaid
PA0016938110005Medicaid
PA501946OtherHIGHMARK
PA0016938110005Medicaid
PAP00296617Medicare PIN
PA501946FJHMedicare PIN
PASM501946Medicare ID - Type Unspecified