Provider Demographics
NPI:1215920111
Name:SMITH, RONALD NEAL (OD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:NEAL
Last Name:SMITH
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 1:2732 S BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-5412
Mailing Address - Country:US
Mailing Address - Phone:903-597-9020
Mailing Address - Fax:903-597-4049
Practice Address - Street 1:2732 S BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-5412
Practice Address - Country:US
Practice Address - Phone:903-597-9020
Practice Address - Fax:903-597-4049
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2252T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80314QOtherBLUECROSSBLUESHIELD
TX80314QOtherBLUECROSSBLUESHIELD
TXT15986Medicare UPIN