Provider Demographics
NPI:1184076234
Name:SMITH, JUSTIN A (OD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:A
Last Name:SMITH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:581 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:NY
Mailing Address - Zip Code:13421-2452
Mailing Address - Country:US
Mailing Address - Phone:315-363-6210
Mailing Address - Fax:315-363-6210
Practice Address - Street 1:581 MAIN ST
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-2452
Practice Address - Country:US
Practice Address - Phone:315-363-6210
Practice Address - Fax:315-363-6210
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-12
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008491152W00000X
NY008491-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist