Provider Demographics
NPI:1942316054
Name:SMITH, ALAN RICHARD (OD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:RICHARD
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 1:2583 N MIRANDA AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-9051
Mailing Address - Country:US
Mailing Address - Phone:208-895-0831
Mailing Address - Fax:
Practice Address - Street 1:2100 12TH AVE RD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-6441
Practice Address - Country:US
Practice Address - Phone:208-467-5293
Practice Address - Fax:208-467-5359
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-1060152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010148906OtherREGENCE
ID15392OtherSPECTERA
IDV5228OtherBLUE CROSS
ID1593928Medicare ID - Type Unspecified
ID000010148906OtherREGENCE