Provider Demographics
NPI:1841676095
Name:SMITH, LAUREN ALEXANDRA (OD)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:ALEXANDRA
Last Name:SMITH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5919 HARBOUR PARK DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-2163
Mailing Address - Country:US
Mailing Address - Phone:804-739-8646
Mailing Address - Fax:804-739-9651
Practice Address - Street 1:5919 HARBOUR PARK DR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112
Practice Address - Country:US
Practice Address - Phone:804-739-8646
Practice Address - Fax:804-739-9651
Is Sole Proprietor?:No
Enumeration Date:2015-08-10
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1985DT152W00000X
VA0618002643152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0618002643OtherSTATE LICENSE
KY1985DTOtherSTATE LICENSE