Provider Demographics
NPI:1528153202
Name:SMITH, TODD RIPLEY (OD)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:RIPLEY
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 1:1730 HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:TX
Mailing Address - Zip Code:76384-7715
Mailing Address - Country:US
Mailing Address - Phone:940-552-2204
Mailing Address - Fax:940-552-2210
Practice Address - Street 1:1730 HOUSTON ST
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:TX
Practice Address - Zip Code:76384-7715
Practice Address - Country:US
Practice Address - Phone:940-552-2204
Practice Address - Fax:940-552-2210
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4713TG152W00000X, 332H00000X
TX4713T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113303501Medicaid
TX1219280001OtherPALMETTO GBA DMERC
TX00E34ZOtherBCBS
TX410038613OtherRAILROAD MEDICARE
TX113303501Medicaid
00130EMedicare PIN