Provider Demographics
NPI:1861017253
Name:SMITH, MERCEDES DELGAUDIO (OD)
Entity Type:Individual
Prefix:DR
First Name:MERCEDES
Middle Name:DELGAUDIO
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 1:2 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05156-3501
Mailing Address - Country:US
Mailing Address - Phone:802-885-4190
Mailing Address - Fax:
Practice Address - Street 1:2 SUMMER ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VT
Practice Address - Zip Code:05156-3501
Practice Address - Country:US
Practice Address - Phone:802-885-4190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-11
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT030.0133928152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist