Healthcare Provider Details

I. General information

NPI: 1346347655
Provider Name (Legal Business Name): BRENT ELLIOT SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13918 RIVERBIRCH TRACE RD
MIDLOTHIAN VA
23112-4639
US

IV. Provider business mailing address

13918 RIVERBIRCH TRACE RD
MIDLOTHIAN VA
23112-4639
US

V. Phone/Fax

Practice location:
  • Phone: 804-334-0923
  • Fax:
Mailing address:
  • Phone: 804-334-0923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101033096
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: