Healthcare Provider Details

I. General information

NPI: 1033218904
Provider Name (Legal Business Name): SMITH & SMITH OPTOMETRIST INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 COLLEGE AVE
ALVA OK
73717-2222
US

IV. Provider business mailing address

PO BOX 969
ALVA OK
73717-0969
US

V. Phone/Fax

Practice location:
  • Phone: 580-327-2393
  • Fax: 580-327-2396
Mailing address:
  • Phone: 580-327-2393
  • Fax: 580-327-2396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number1015
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1015
License Number StateOK

VIII. Authorized Official

Name: DR. TROY L SMITH
Title or Position: PRESIDENT
Credential: OK
Phone: 580-327-2393