Healthcare Provider Details

I. General information

NPI: 1457973984
Provider Name (Legal Business Name): EMILY SMITH OD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2020
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1931 SHERIDAN BLVD UNIT S
EDGEWATER CO
80214-1300
US

IV. Provider business mailing address

755 S PERRY ST STE 100
CASTLE ROCK CO
80104-1923
US

V. Phone/Fax

Practice location:
  • Phone: 303-578-8055
  • Fax:
Mailing address:
  • Phone: 720-531-0688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0003704
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: