Provider Demographics
NPI:1780711564
Name:SMARCH, DARREN (OD)
Entity type:Individual
Prefix:
First Name:DARREN
Middle Name:
Last Name:SMARCH
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 1:20 W WASHINGTON ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-1576
Mailing Address - Country:US
Mailing Address - Phone:313-729-7483
Mailing Address - Fax:
Practice Address - Street 1:20 W. WASHINGTON
Practice Address - Street 2:SUITE 7
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346
Practice Address - Country:US
Practice Address - Phone:313-729-7483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004205152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI2076Medicare PIN