MEDICARE: JENNIFER STEWART SMITH OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1894-830AT	LA

General Provider Information

NPI Number	:	1255983557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER STEWART SMITH OD

Provider Business Mailing Address
First Line	:	5737 E DIETRICH LOOP
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-7198
Country	:	US
Telephone Number	:	337-309-0438
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 W MCNEESE ST
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-5528
Country	:	US
Telephone Number	:	337-474-6161
Fax Number	:	337-474-6474

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2019
Last Update Date	:	03/09/2022

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