Provider Demographics
NPI:1649272436
Name:SMITH, RONALD JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:JAMES
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1807 WILSHIRE BLVD STE 203
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5790
Practice Address - Country:US
Practice Address - Phone:310-829-0160
Practice Address - Fax:310-829-0170
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2025-01-29
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-04-11
Provider Licenses
StateLicense IDTaxonomies
CAG081227207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG0812227OtherLICENSE NUMBER
CA2981136Medicaid
CA2981136Medicaid
CAG0812227OtherLICENSE NUMBER