Provider Demographics
NPI:1154339687
Name:SMITHSON, KEITH (OD)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:SMITHSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7263E ARLINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-3219
Mailing Address - Country:US
Mailing Address - Phone:703-573-1200
Mailing Address - Fax:703-573-1250
Practice Address - Street 1:11656 PLAZA AMERICA DR
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-4767
Practice Address - Country:US
Practice Address - Phone:703-467-9080
Practice Address - Fax:703-467-9082
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001041152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA383934OtherANTHEM BCBS/RESTON
VA383935OtherANTHEM BCBS/ALEXANDRIA
VA009232231Medicaid
VA2663321OtherAETNA HMO
VA7671300OtherAETNA PPO
VA9314-0007OtherBCBS/CAREFIRST
VA295571OtherMAMSI/ALLIANCE
VA009232231Medicaid
VA9314-0007OtherBCBS/CAREFIRST