Provider Demographics
NPI:1962545822
Name:SMITH, LOWELL ROBERT (OD)
Entity type:Individual
Prefix:DR
First Name:LOWELL
Middle Name:ROBERT
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 1:11936 IMPERIAL HWY STE F
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-0406
Mailing Address - Country:US
Mailing Address - Phone:562-864-5787
Mailing Address - Fax:
Practice Address - Street 1:11936 IMPERIAL HWY STE F
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-0406
Practice Address - Country:US
Practice Address - Phone:562-864-5787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2013-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT7578T152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0075780Medicaid
CASD0075780Medicaid
U76395Medicare UPIN
OP7578Medicare ID - Type Unspecified