Provider Demographics
NPI:1255431383
Name:SMITH, ROBERT NEWTON (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:NEWTON
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:PO BOX 38
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:KS
Mailing Address - Zip Code:66748-0038
Mailing Address - Country:US
Mailing Address - Phone:620-473-2772
Mailing Address - Fax:620-473-3573
Practice Address - Street 1:624 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:HUMBOLDT
Practice Address - State:KS
Practice Address - Zip Code:66748-1733
Practice Address - Country:US
Practice Address - Phone:620-473-2772
Practice Address - Fax:620-473-3573
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS1212-2152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100218130-BMedicaid
KS100218130-AMedicaid
KS018066Medicare PIN
KS100218130-AMedicaid
KS0936380001Medicare NSC
KS0936380002Medicare NSC
KS100218130-BMedicaid