Provider Demographics
NPI:1649692575
Name:LOREN DONNELL SMITH OD INC
Entity type:Organization
Organization Name:LOREN DONNELL SMITH OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMO/
Authorized Official - Prefix:DR
Authorized Official - First Name:LOREN
Authorized Official - Middle Name:DONNELL
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:510-796-3937
Mailing Address - Street 1:35149 NEWARK BLVD
Mailing Address - Street 2:STE C
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-1209
Mailing Address - Country:US
Mailing Address - Phone:510-796-3937
Mailing Address - Fax:
Practice Address - Street 1:35149 NEWARK BLVD
Practice Address - Street 2:STE C
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560-1209
Practice Address - Country:US
Practice Address - Phone:510-796-3937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-13
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA07354TLG261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0073540Medicaid
CAWOP07354AMedicare PIN
CAU32025Medicare UPIN