Healthcare Provider Details

I. General information

NPI: 1538165659
Provider Name (Legal Business Name): CALDWELL WITHERS SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 EDDY ST
PROVIDENCE RI
02903-4928
US

IV. Provider business mailing address

690 EDDY ST
PROVIDENCE RI
02903-4928
US

V. Phone/Fax

Practice location:
  • Phone: 401-274-5844
  • Fax: 401-274-9462
Mailing address:
  • Phone: 401-274-5844
  • Fax: 401-274-9462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD5399
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number38194
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: