Healthcare Provider Details

I. General information

NPI: 1932418019
Provider Name (Legal Business Name): ROBERT B SMITH O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2010
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1022 WILLOW CREEK RD
PRESCOTT AZ
86301-1607
US

IV. Provider business mailing address

1022 WILLOW CREEK RD
PRESCOTT AZ
86301-1607
US

V. Phone/Fax

Practice location:
  • Phone: 928-445-1341
  • Fax:
Mailing address:
  • Phone: 928-205-3844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT002832
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: