Provider Demographics
NPI:1841474673
Name:OSCAR A. SMITH, O.D.
Entity type:Organization
Organization Name:OSCAR A. SMITH, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:601-736-5396
Mailing Address - Street 1:PO BOX 1247
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MS
Mailing Address - Zip Code:39429-1247
Mailing Address - Country:US
Mailing Address - Phone:601-736-5396
Mailing Address - Fax:601-736-0182
Practice Address - Street 1:317 CHURCH ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MS
Practice Address - Zip Code:39429-2725
Practice Address - Country:US
Practice Address - Phone:601-736-5396
Practice Address - Fax:601-736-0182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS465152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00087835Medicaid
MS2230037OtherUNITED HEALTH CARE
MS1841474673OtherMEDICARE NPI
T20833Medicare UPIN
MS00087835Medicaid