Provider Demographics
NPI:1992769020
Name:SMITH, RAY D (CPO, LPO)
Entity type:Individual
Prefix:MR
First Name:RAY
Middle Name:D
Last Name:SMITH
Suffix:
Gender:M
Credentials:CPO, LPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4646
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77903-4646
Mailing Address - Country:US
Mailing Address - Phone:361-575-2877
Mailing Address - Fax:361-575-5111
Practice Address - Street 1:304 GEMINI CT
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-2679
Practice Address - Country:US
Practice Address - Phone:361-575-2877
Practice Address - Fax:361-575-5111
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXLPO43OtherTX BOARD OF P & O