Provider Demographics
NPI:1063699700
Name:SMITH, ODELL ARTTO JR (OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:ODELL
Middle Name:ARTTO
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 N EUTAW ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-4648
Mailing Address - Country:US
Mailing Address - Phone:443-797-7754
Mailing Address - Fax:410-225-8329
Practice Address - Street 1:821 N EUTAW ST
Practice Address - Street 2:SUITE 303
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-4648
Practice Address - Country:US
Practice Address - Phone:443-797-7754
Practice Address - Fax:410-225-8329
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician