MEDICARE: MARK P SMITH O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPT001254	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124046735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK P SMITH O.D.

Provider Business Mailing Address
First Line	:	PO BOX 11407
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35246-8575
Country	:	US
Telephone Number	:	864-359-1308
Fax Number	:	239-496-3939

Provider Business Practice Location Address
First Line	:	6600 WHITTLESEY BLVD BLDG A
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-7337
Country	:	US
Telephone Number	:	706-323-3491
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	04/30/2026

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