MEDICARE: LOREN D SMITH OD INC

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	07354T	CA

General Provider Information

NPI Number	:	1538150396
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOREN D SMITH OD INC

Provider Business Mailing Address
First Line	:	11502 S VERMONT AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90044-6522
Country	:	US
Telephone Number	:	323-756-3937
Fax Number	:	323-756-3938

Provider Business Practice Location Address
First Line	:	11502 S VERMONT AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90044-6522
Country	:	US
Telephone Number	:	323-756-3937
Fax Number	:	323-756-3938

Authorized Official
Title or Position	:	PRES/COO
Name	:	DR. LOREN DONNELL SMITH
Credential	:	OD (OCULUS DOCTOR)
Telephone Number	:	323-756-3937

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	08/22/2020

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