Healthcare Provider Details

I. General information

NPI: 1407142151
Provider Name (Legal Business Name): JESSE M SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11960 LIONESS WAY STE 290
PARKER CO
80134-5640
US

IV. Provider business mailing address

255 S ROUTT ST STE 200
LAKEWOOD CO
80228-2271
US

V. Phone/Fax

Practice location:
  • Phone: 303-261-1600
  • Fax:
Mailing address:
  • Phone: 303-261-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberDR.0058513
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberDR.0058513
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: