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General NPI Number Information
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NPI Number | 1235420712
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Entity Type | Organization
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Legal Business Name | DOCTOR SMITH: EYE CARE, PA
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Dates
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Enumeration Date | 05/02/2011
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Last Update Date | 05/02/2011
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Provider Practice Location Address
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Address Line | 1890 NE PINE ISLAND RD
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City | CAPE CORAL
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State | FL
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Zip | 33909-1733
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Country | US
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Telephone | 239-573-4743
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Fax |
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Provider Business Mailing Address
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Address Line | 1104 NE 2ND TER
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City | CAPE CORAL
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State | FL
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Zip | 33909-2655
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RODNEY JOHN SMITH
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Credential |
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Telephone | 239-573-4743
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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 | OPC3175
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License Number State | FL
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