Provider Demographics
NPI:1356426878
Name:SMITH, JEFFERY W (OD, MBA)
Entity type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:W
Last Name:SMITH
Suffix:
Gender:M
Credentials:OD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 W 74TH PL
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-5058
Mailing Address - Country:US
Mailing Address - Phone:305-557-9004
Mailing Address - Fax:305-362-2885
Practice Address - Street 1:285 W 74TH PL
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-5058
Practice Address - Country:US
Practice Address - Phone:305-557-9004
Practice Address - Fax:305-362-2885
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL46007637152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist