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General NPI Number Information
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NPI Number | 1386047256
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Entity Type | Organization
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Legal Business Name | DR. PENNY B. SMYTHE, INC., PC
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Dates
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Enumeration Date | 10/06/2014
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Last Update Date | 10/06/2014
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Provider Practice Location Address
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Address Line | 1157 N. YORK ST.
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City | MUSKOGEE
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State | OK
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Zip | 74403
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Country | US
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Telephone | 918-683-8404
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Fax | 918-687-4469
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Provider Business Mailing Address
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Address Line | 1157 N. YORK ST.
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City | MUSKOGEE
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State | OK
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Zip | 74403
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Country | US
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Telephone | 918-683-8404
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Fax | 918-687-4469
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | PENNY B SMYTHE
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Credential | O.D.
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Telephone | 918-616-1634
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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 | 2083
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License Number State | OK
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