Provider Demographics
NPI:1720084882
Name:SMITH, NORMAN LEE (OD)
Entity type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:LEE
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 1:5431 EVERHART RD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4805
Mailing Address - Country:US
Mailing Address - Phone:361-851-2020
Mailing Address - Fax:361-852-1210
Practice Address - Street 1:5431 EVERHART RD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4805
Practice Address - Country:US
Practice Address - Phone:361-851-2020
Practice Address - Fax:361-852-1210
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2490TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80313EOtherBLUE CROSS BLUE SHIELD
TXT15950Medicare UPIN
TX80313EMedicare ID - Type Unspecified