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General NPI Number Information
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NPI Number | 1225342074
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Entity Type | Individual
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Provider Name | CHARLES D SMITH OD
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Gender | Male
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Dates
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Enumeration Date | 08/04/2010
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Last Update Date | 08/21/2023
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Provider Practice Location Address
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Address Line | 1327 TROUP HWY
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City | TYLER
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State | TX
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Zip | 75701-4443
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Country | US
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Telephone | 903-531-4733
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 846098
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City | DALLAS
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State | TX
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Zip | 75284-6098
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Country | US
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Telephone | 903-324-6450
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 7613T
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License Number State | TX
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