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NPI Code Detail

MEDICARE: DR. RANDY DELL SMART O.D.

MEDICARE: DR. RANDY DELL SMART 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
1152W00000XOptometristOPT6555TPACA

Other Identifiers

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

General Provider Information

NPI Number : 1982697207
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RANDY DELL SMART O.D.
Provider Business Mailing Address
First Line : 1518 W BRANCH ST
Second Line :
City : ARROYO GRANDE
State : CA
Zip : 93420-1817
Country : US
Telephone Number : 805-489-8467
Fax Number : 805-489-8612
Provider Business Practice Location Address
First Line : 1518 W BRANCH ST
Second Line :
City : ARROYO GRANDE
State : CA
Zip : 93420-1817
Country : US
Telephone Number : 805-489-8467
Fax Number : 805-489-8612
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2005
Last Update Date : 09/28/2011

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Directions to “ DR. RANDY DELL SMART O.D.” Practice Location

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