MEDICARE: SMITH OPTOMETRY PC

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	TUV005868	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356360549
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMITH OPTOMETRY PC

Provider Business Mailing Address
First Line	:	401 E 34TH ST
Second Line	:	SOUTH 3B
City	:	NEW YORK
State	:	NY
Zip	:	10016-4914
Country	:	US
Telephone Number	:	212-679-0766
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 E 34TH ST
Second Line	:	SOUTH 3B
City	:	NEW YORK
State	:	NY
Zip	:	10016-4914
Country	:	US
Telephone Number	:	212-679-0766
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KENNETH C SMITH
Credential	:
Telephone Number	:	212-679-0766

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	04/07/2012

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