Provider Demographics
NPI:1063608065
Name:SMITH, FLOYD M (OD)
Entity type:Individual
Prefix:DR
First Name:FLOYD
Middle Name:M
Last Name:SMITH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:372 KINDERKAMACK RD
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-1653
Mailing Address - Country:US
Mailing Address - Phone:201-666-2021
Mailing Address - Fax:201-666-8032
Practice Address - Street 1:372 KINDERKAMACK RD
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-1653
Practice Address - Country:US
Practice Address - Phone:201-666-2021
Practice Address - Fax:201-666-8032
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA 4245152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ30257OtherAETNA PROVIDER NUMBER
NJ0186950001Medicare NSC
U32941Medicare UPIN