Provider Demographics
NPI:1194777185
Name:SMOLYAR, ALBERT E (MD)
Entity type:Individual
Prefix:
First Name:ALBERT
Middle Name:E
Last Name:SMOLYAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6850 INTERNATIONAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-7129
Mailing Address - Country:US
Mailing Address - Phone:239-768-0006
Mailing Address - Fax:239-768-0850
Practice Address - Street 1:6850 INTERNATIONAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912
Practice Address - Country:US
Practice Address - Phone:239-768-0006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.130104207W00000X
IN01059189A207W00000X
KY37798207W00000X
FLME136187207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH544050OtherMEDICARE OH CORNELL RD
OHH544051OtherMEDICARE OH UNION CENTRE
KYK134521OtherMEDICARE KY
FLJJ389ZOtherMEDICARE FL
OHH544050OtherMEDICARE OH MONTGOMERY RD
OH0198505Medicaid
KY64129703Medicaid