MEDICARE: DR. DENNIS E SMITH O.D.

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	6051T	TX

General Provider Information

NPI Number	:	1609973163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENNIS E SMITH O.D.

Provider Business Mailing Address
First Line	:	10601 RANCH ROAD 2222
Second Line	:	STE. G
City	:	AUSTIN
State	:	TX
Zip	:	78730-1134
Country	:	US
Telephone Number	:	512-343-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	10601 RANCH ROAD 2222
Second Line	:	STE. G
City	:	AUSTIN
State	:	TX
Zip	:	78730-1134
Country	:	US
Telephone Number	:	512-343-2020
Fax Number	:

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

Provider Enumeration Date	:	09/19/2006
Last Update Date	:	07/08/2007

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