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General NPI Number Information
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NPI Number | 1588807028
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Entity Type | Organization
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Legal Business Name | JACOB T SMITH OD PLLC
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Dates
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Enumeration Date | 04/14/2009
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Last Update Date | 12/01/2010
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Provider Practice Location Address
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Address Line | 3720 W ROBINSON ST STE 118
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City | NORMAN
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State | OK
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Zip | 73072-3640
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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 STE 118
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City | NORMAN
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State | OK
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Zip | 73072-3640
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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 | OPTOMETRIST
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Name | DR. JACOB TYLER 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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2503
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License Number State | OK
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