MEDICARE: DR. CLEO HERBERT SMITH JR. 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	604	SC
2	152W00000X	Optometrist	0986	NC

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447235742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLEO HERBERT SMITH JR. O.D.

Provider Business Mailing Address
First Line	:	1729 NEW HANOVER MEDICAL PARK DR
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-5345
Country	:	US
Telephone Number	:	910-763-3601
Fax Number	:

Provider Business Practice Location Address
First Line	:	1176 E CUTLAR XING
Second Line	:
City	:	LELAND
State	:	NC
Zip	:	28451-6426
Country	:	US
Telephone Number	:	910-763-3601
Fax Number	:	910-763-4608

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

Provider Enumeration Date	:	12/08/2005
Last Update Date	:	03/09/2025

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