Provider Demographics
NPI:1427267673
Name:PETER C SMITH
Entity type:Organization
Organization Name:PETER C SMITH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:C
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-446-7578
Mailing Address - Street 1:610 LAKEVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3336
Mailing Address - Country:US
Mailing Address - Phone:727-446-7578
Mailing Address - Fax:727-447-1716
Practice Address - Street 1:610 LAKEVIEW RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3336
Practice Address - Country:US
Practice Address - Phone:727-446-7578
Practice Address - Fax:727-447-1716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME57479332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL064436600Medicaid
FL990010535OtherRAILROAD MEDICARE
FL064436600Medicaid