Provider Demographics
NPI:1669533386
Name:SMET, REGINE RAYMONDE (OD)
Entity type:Individual
Prefix:
First Name:REGINE
Middle Name:RAYMONDE
Last Name:SMET
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11792 SILVER FOX RD
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-4222
Mailing Address - Country:US
Mailing Address - Phone:310-702-8782
Mailing Address - Fax:
Practice Address - Street 1:5401 KATELLA AVE
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90720-2809
Practice Address - Country:US
Practice Address - Phone:714-995-5725
Practice Address - Fax:714-761-5797
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT9701TPG152W00000X
CAOPT 9701T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11145OtherSPECTERA PROVIDER NUMBER
CA27903OtherSPECTERA PROVIDER NUMBER