Provider Demographics
NPI:1538277330
Name:SMITH, LIONEL L (MD)
Entity type:Individual
Prefix:MR
First Name:LIONEL
Middle Name:L
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4313 I-49 SOUTH SERVICE RD.
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570
Mailing Address - Country:US
Mailing Address - Phone:337-942-2024
Mailing Address - Fax:337-948-6216
Practice Address - Street 1:4313 I-49 SOUTH SERVICE RD.
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570
Practice Address - Country:US
Practice Address - Phone:337-942-2024
Practice Address - Fax:337-948-6216
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11657207W00000X
LA011657207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1147877Medicaid
LA5H812Medicare ID - Type Unspecified
B89076Medicare UPIN