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General NPI Number Information
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NPI Number | 1427267673
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Entity Type | Organization
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Legal Business Name | PETER C SMITH
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 04/08/2008
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Provider Practice Location Address
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Address Line | 610 LAKEVIEW RD
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City | CLEARWATER
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State | FL
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Zip | 33756-3336
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Country | US
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Telephone | 727-446-7578
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Fax | 727-447-1716
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Provider Business Mailing Address
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Address Line | 610 LAKEVIEW RD
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City | CLEARWATER
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State | FL
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Zip | 33756-3336
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Country | US
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Telephone | 727-446-7578
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Fax | 727-447-1716
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Authorized Official
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Title or Position | SUPERVISOR
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Name | PETER C. SMITH
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Credential | MD
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Telephone | 727-446-7578
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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 | ME57479
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License Number State | FL
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