Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 465 | MS |
NPI | 1003917360 |
---|---|
Provider Name | Dr. Oscar A Smith |
First Address | Columbia, MS 39429-0548 |
Second Address | Columbia, MS 39429 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 18/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00087835 | (05) | MS |
2230037 | UNITED HEALTHCARE (01) | MS |
T20833 | (02) | MS |