MEDICARE: PETER C SMITH

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	332H00000X	Eyewear Supplier	ME57479	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	990010535	OTHER	FL	RAILROAD MEDICARE

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	:	1427267673
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETER C SMITH

Provider Business Mailing Address
First Line	:	610 LAKEVIEW RD
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33756-3336
Country	:	US
Telephone Number	:	727-446-7578
Fax Number	:	727-447-1716

Provider Business Practice Location Address
First Line	:	610 LAKEVIEW RD
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33756-3336
Country	:	US
Telephone Number	:	727-446-7578
Fax Number	:	727-447-1716

Authorized Official
Title or Position	:	SUPERVISOR
Name	:	PETER C. SMITH
Credential	:	MD
Telephone Number	:	727-446-7578

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	04/08/2008

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