Provider Demographics
NPI:1922118108
Name:SMITH, WALTON FLOYD (OD)
Entity Type:Individual
Prefix:DR
First Name:WALTON
Middle Name:FLOYD
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 1:1450 SUGARLAND DR
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-5730
Mailing Address - Country:US
Mailing Address - Phone:307-673-5177
Mailing Address - Fax:307-673-5170
Practice Address - Street 1:1450 SUGARLAND DR
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-5730
Practice Address - Country:US
Practice Address - Phone:307-673-5177
Practice Address - Fax:307-673-5170
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY231T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0480556Medicaid
WY0220150001Medicare NSC
WYW307653Medicare PIN
MT0480556Medicaid