Provider Demographics
NPI:1962631002
Name:SMITH, ANTHONY JOSEPH (OD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JOSEPH
Last Name:SMITH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:461 OLDS ST
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49250-9433
Mailing Address - Country:US
Mailing Address - Phone:517-849-9277
Mailing Address - Fax:517-849-2134
Practice Address - Street 1:461 OLDS ST
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:MI
Practice Address - Zip Code:49250-9433
Practice Address - Country:US
Practice Address - Phone:517-849-9277
Practice Address - Fax:517-849-2134
Is Sole Proprietor?:No
Enumeration Date:2009-07-10
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4600152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist