Provider Demographics
NPI:1942408869
Name:SMITH, DAVID RAYMOND (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RAYMOND
Last Name:SMITH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:8685 OLIVE BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63132-1205
Mailing Address - Country:US
Mailing Address - Phone:314-219-5461
Mailing Address - Fax:314-219-5464
Practice Address - Street 1:8685 OLIVE BOULEVARD
Practice Address - Street 2:
Practice Address - City:UNIVERSITY CITY
Practice Address - State:MO
Practice Address - Zip Code:63132-6313
Practice Address - Country:US
Practice Address - Phone:314-219-5461
Practice Address - Fax:314-219-5464
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007019153152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1942408869Medicaid
MO0360070001Medicare NSC
MO1942408869Medicaid
MOU51024Medicare UPIN