Provider Demographics
NPI:1891820049
Name:SMOOKLER, MICHAEL L (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
Last Name:SMOOKLER
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 1:101 STATE ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-2908
Mailing Address - Country:US
Mailing Address - Phone:617-742-3937
Mailing Address - Fax:
Practice Address - Street 1:101 STATE ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109-2908
Practice Address - Country:US
Practice Address - Phone:617-742-3937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3546152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA152798OtherHARVARD HEALTH PLAN
MA0391921Medicaid
MA732742OtherTUFTS HEALTH PLAN
MAW25180OtherBLUE CROSS BLUE
MA152798OtherHARVARD HEALTH PLAN