Provider Demographics
NPI:1386047256
Name:DR. PENNY B. SMYTHE, INC., PC
Entity type:Organization
Organization Name:DR. PENNY B. SMYTHE, INC., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:B
Authorized Official - Last Name:SMYTHE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:918-616-1634
Mailing Address - Street 1:1157 N. YORK ST.
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403
Mailing Address - Country:US
Mailing Address - Phone:918-683-8404
Mailing Address - Fax:918-687-4469
Practice Address - Street 1:1157 N. YORK ST.
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403
Practice Address - Country:US
Practice Address - Phone:918-683-8404
Practice Address - Fax:918-687-4469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-06
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2083152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100766280AMedicaid
OK433074Medicare UPIN