Healthcare Provider Details

I. General information

NPI: 1922203363
Provider Name (Legal Business Name): CAMERON E SMITH, OD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2007
Last Update Date: 03/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 HIGHWAY 287 N
MANSFIELD TX
76063-8852
US

IV. Provider business mailing address

1650 HIGHWAY 287 N
MANSFIELD TX
76063-8852
US

V. Phone/Fax

Practice location:
  • Phone: 682-518-1177
  • Fax:
Mailing address:
  • Phone: 682-518-1177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5925TG
License Number StateTX

VIII. Authorized Official

Name: DR. CAMERON E SMITH
Title or Position: PRESIDENT
Credential: O.D.
Phone: 682-429-3600