MEDICARE: S. SCOTT SMITH I 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	OD00003239	WA

General Provider Information

NPI Number	:	1861582892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	S. SCOTT SMITH I OD

Provider Business Mailing Address
First Line	:	5229 154 A AVE
Second Line	:
City	:	EDMONTON
State	:	ALBERTA
Zip	:	T5Y 2S5
Country	:	CA
Telephone Number	:	780-476-6887
Fax Number	:

Provider Business Practice Location Address
First Line	:	299 W TIETAN ST
Second Line	:
City	:	WALLA WALLA
State	:	WA
Zip	:	99362-4363
Country	:	US
Telephone Number	:	509-525-2100
Fax Number	:	509-522-0313

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

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	07/24/2008

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Directions to “ S. SCOTT SMITH I OD” Practice Location

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