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General NPI Number Information
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NPI Number | 1417185349
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Entity Type | Organization
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Legal Business Name | JACOB T. SMITH, O.D. PLLC
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Dates
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Enumeration Date | 06/30/2009
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Last Update Date | 06/30/2009
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Provider Practice Location Address
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Address Line | 3720 W ROBINSON ST SUITE 118
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City | NORMAN
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State | OK
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Zip | 73072-3657
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Country | US
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Telephone | 405-447-5001
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Fax | 405-447-4680
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Provider Business Mailing Address
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Address Line | 3720 W ROBINSON ST SUITE 118
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City | NORMAN
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State | OK
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Zip | 73072-3657
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Country | US
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Telephone | 405-447-5001
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Fax | 405-447-4680
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | DR. JACOB T SMITH
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Credential | O.D.
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Telephone | 405-447-5001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 2503
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License Number State | OK
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