Provider Demographics
NPI:1396742854
Name:SMAIL, ALEC J (OD)
Entity type:Individual
Prefix:
First Name:ALEC
Middle Name:J
Last Name:SMAIL
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 1:172 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-2921
Mailing Address - Country:US
Mailing Address - Phone:781-229-2639
Mailing Address - Fax:781-312-7702
Practice Address - Street 1:172 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-2921
Practice Address - Country:US
Practice Address - Phone:781-229-2639
Practice Address - Fax:781-312-7702
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3925152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0337510Medicaid
CE5062OtherRAILROAD MEDICARE
MA0337510Medicaid
CE5062OtherRAILROAD MEDICARE