Provider Demographics
NPI:1295966927
Name:SMITH, MEGAN LYNN (OD)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:LYNN
Other - Last Name:CROWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:105 SCIENCE ST
Mailing Address - Street 2:
Mailing Address - City:PARK HILLS
Mailing Address - State:MO
Mailing Address - Zip Code:63601-2529
Mailing Address - Country:US
Mailing Address - Phone:573-200-8732
Mailing Address - Fax:
Practice Address - Street 1:537 W KARSCH BLVD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-3312
Practice Address - Country:US
Practice Address - Phone:573-747-4133
Practice Address - Fax:573-747-4533
Is Sole Proprietor?:No
Enumeration Date:2009-07-29
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC004476152W00000X
MO2009019492152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000006438OtherMEDICARE PTAN
MO1295966927Medicaid
MOMA2674002Medicare PIN
MO0360070001Medicare NSC