Provider Demographics
NPI:1720356454
Name:SMITH, S. CRAIG (OD)
Entity Type:Individual
Prefix:DR
First Name:S. CRAIG
Middle Name:
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 1:1800 LAWRENCE ST
Mailing Address - Street 2:SUITE 100 A
Mailing Address - City:GAINESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76240-2200
Mailing Address - Country:US
Mailing Address - Phone:214-893-2306
Mailing Address - Fax:
Practice Address - Street 1:1800 LAWRENCE ST
Practice Address - Street 2:SUITE 100 A
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240-2200
Practice Address - Country:US
Practice Address - Phone:214-893-2306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4577T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist