Provider Demographics
NPI:1316255227
Name:DR SHELDON K SMITH, OPTOMETRIST INC.
Entity type:Organization
Organization Name:DR SHELDON K SMITH, OPTOMETRIST INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELDON
Authorized Official - Middle Name:K
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:530-662-2020
Mailing Address - Street 1:316 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-3141
Mailing Address - Country:US
Mailing Address - Phone:530-662-2020
Mailing Address - Fax:530-662-8642
Practice Address - Street 1:316 WALNUT ST
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-3141
Practice Address - Country:US
Practice Address - Phone:530-662-2020
Practice Address - Fax:530-662-8642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4612302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGSD000360Medicaid