Provider Demographics
NPI:1538415054
Name:DOCTOR SMITH EYE CARE PA
Entity type:Organization
Organization Name:DOCTOR SMITH EYE CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:239-573-4742
Mailing Address - Street 1:1104 NE 2ND TER
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-2655
Mailing Address - Country:US
Mailing Address - Phone:239-573-4742
Mailing Address - Fax:239-573-6160
Practice Address - Street 1:1104 NE 2ND TER
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-2655
Practice Address - Country:US
Practice Address - Phone:239-573-4742
Practice Address - Fax:239-573-6160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-02
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3175152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty