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General NPI Number Information
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NPI Number | 1912591884
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Entity Type | Individual
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Provider Name | ADAM RICHARD SMITH OD
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Gender | Male
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Dates
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Enumeration Date | 02/22/2021
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Last Update Date | 03/05/2022
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Provider Practice Location Address
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Address Line | 450 NW GILMAN BLVD STE 104
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City | ISSAQUAH
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State | WA
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Zip | 98027-2483
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Country | US
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Telephone | 425-392-8756
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Fax |
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Provider Business Mailing Address
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Address Line | 4450 189TH PL SE
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City | ISSAQUAH
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State | WA
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Zip | 98027-9710
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Country | US
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Telephone | 425-269-0320
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | OPT.006923
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OD61217146
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License Number State | WA
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