Provider Demographics
NPI:1649275850
Name:SMITH, DONALD S (OD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:S
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 1:3095 HARLEM RD
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-2500
Mailing Address - Country:US
Mailing Address - Phone:716-896-8831
Mailing Address - Fax:716-896-2318
Practice Address - Street 1:696 S OGDEN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14206-2317
Practice Address - Country:US
Practice Address - Phone:716-896-8831
Practice Address - Fax:716-896-2318
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2016-09-14
Deactivation Date:2006-02-17
Deactivation Code:
Reactivation Date:2006-04-01
Provider Licenses
StateLicense IDTaxonomies
NYVUT004019152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC2817Medicare UPIN
NYT25875Medicare UPIN