Provider Demographics
NPI:1972613313
Name:SMITH, BOYKIN BAIRD (OD)
Entity type:Individual
Prefix:DR
First Name:BOYKIN
Middle Name:BAIRD
Last Name:SMITH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:16032 15 MILE BLVD
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24211-1106
Mailing Address - Country:US
Mailing Address - Phone:276-676-3937
Mailing Address - Fax:276-623-0264
Practice Address - Street 1:16032 15 MILE BLVD
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24211-1106
Practice Address - Country:US
Practice Address - Phone:276-676-3937
Practice Address - Fax:276-623-0264
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001774152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL659160Medicare UPIN
IL371119724OtherTAX ID #
ILMS1383948OtherDEA #