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General NPI Number Information
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NPI Number | 1205004975
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Entity Type | Organization
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Legal Business Name | STEVEN D SMITH AN OPTOMETRIC CORPORATION
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Dates
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Enumeration Date | 02/15/2008
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Last Update Date | 04/26/2018
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Provider Practice Location Address
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Address Line | 30212 TOMAS SUITE 170
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City | RANCHO SANTA MARGARITA
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State | CA
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Zip | 92688-2174
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Country | US
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Telephone | 949-589-0900
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Fax |
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Provider Business Mailing Address
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Address Line | 30212 TOMAS SUITE 170
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City | RANCHO SANTA MARGARITA
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State | CA
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Zip | 92688-2174
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Country | US
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Telephone | 949-589-0900
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STEVEN DONALD SMITH
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Credential |
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Telephone | 949-589-0900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 9092T
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License Number State | CA
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