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General NPI Number Information
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NPI Number | 1619216355
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Entity Type | Organization
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Legal Business Name | BENJAMIN D. SMITH OD, LLC
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Dates
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Enumeration Date | 01/31/2013
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Last Update Date | 02/06/2015
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Provider Practice Location Address
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Address Line | 1041 ACOMA ST
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City | DENVER
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State | CO
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Zip | 80204-4034
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Country | US
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Telephone | 720-255-2412
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Fax | 720-536-8283
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Provider Business Mailing Address
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Address Line | 1041 ACOMA ST
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City | DENVER
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State | CO
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Zip | 80204-4034
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Country | US
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Telephone | 720-255-2412
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Fax | 720-536-8283
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Authorized Official
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Title or Position | OWNER
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Name | DR. BENJAMIN DAVID SMITH
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Credential | O.D.
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Telephone | 720-255-2412
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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 | OPT2881
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License Number State | CO
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