MEDICARE: DR. MICHAEL H 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	1117	OK

General Provider Information

NPI Number	:	1659446110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL H SMITH O.D.

Provider Business Mailing Address
First Line	:	3736 NW 50TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-2554
Country	:	US
Telephone Number	:	405-947-1512
Fax Number	:	405-947-1511

Provider Business Practice Location Address
First Line	:	3736 NW 50TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-2554
Country	:	US
Telephone Number	:	405-947-1512
Fax Number	:	405-947-1511

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

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	08/15/2011

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