Provider Demographics
NPI:1831202076
Name:SMITH, TODD FREEMAN (OD)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:FREEMAN
Last Name:SMITH
Suffix:
Gender:
Credentials:OD
Other - Prefix:DR
Other - First Name:TODD
Other - Middle Name:FREEMAN
Other - Last Name:SMITH
Other - Suffix:SR
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:121 ROSETREE LN
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-3111
Mailing Address - Country:US
Mailing Address - Phone:267-738-7702
Mailing Address - Fax:
Practice Address - Street 1:521 W OLNEY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19120-2217
Practice Address - Country:US
Practice Address - Phone:215-224-2347
Practice Address - Fax:215-224-2309
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046011484152W00000X
MDTA2729152W00000X
FLTPOP20152W00000X
NJ27OA00709800152W00000X
MO2020006059152W00000X
GAOPT003290152W00000X
PAOEG000849152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101282210Medicaid
PA096249Medicare ID - Type Unspecified
PAV07431Medicare UPIN