Provider Demographics
NPI:1306264726
Name:DR. SMITH AND ASSOCIATES, PA
Entity type:Organization
Organization Name:DR. SMITH AND ASSOCIATES, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-361-0431
Mailing Address - Street 1:PO BOX 40510
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33743-0510
Mailing Address - Country:US
Mailing Address - Phone:727-361-0431
Mailing Address - Fax:727-344-7952
Practice Address - Street 1:13550 SW 120TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-7397
Practice Address - Country:US
Practice Address - Phone:727-361-0431
Practice Address - Fax:727-344-7952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1883152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty