MEDICARE: JERRY ARMOUR 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	OE 5861-P	PA

General Provider Information

NPI Number	:	1548244023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERRY ARMOUR SMITH O.D.

Provider Business Mailing Address
First Line	:	22 RANCOCAS LN
Second Line	:
City	:	BROWNS MILLS
State	:	NJ
Zip	:	08015-3934
Country	:	US
Telephone Number	:	732-532-5152
Fax Number	:

Provider Business Practice Location Address
First Line	:	1075 STEVENSON AVE
Second Line	:
City	:	FT. MONMOUTH
State	:	NJ
Zip	:	07703
Country	:	US
Telephone Number	:	732-532-5152
Fax Number	:

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

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	07/08/2007

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