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General NPI Number Information
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NPI Number | 1649692575
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Entity Type | Organization
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Legal Business Name | LOREN DONNELL SMITH OD INC
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Dates
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Enumeration Date | 01/13/2014
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Last Update Date | 01/13/2014
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Provider Practice Location Address
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Address Line | 35149 NEWARK BLVD STE C
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City | NEWARK
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State | CA
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Zip | 94560-1209
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Country | US
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Telephone | 510-796-3937
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Fax |
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Provider Business Mailing Address
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Address Line | 35149 NEWARK BLVD STE C
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City | NEWARK
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State | CA
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Zip | 94560-1209
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Country | US
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Telephone | 510-796-3937
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Fax |
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Authorized Official
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Title or Position | CMO/
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Name | DR. LOREN DONNELL SMITH
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Credential | OD
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Telephone | 510-796-3937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 07354TLG
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License Number State | CA
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