Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 1374 | CO |
NPI | 1003958067 |
---|---|
Provider Name | Dr. Tod W. Smith |
First Address | Rifle, CO 81650-2320 |
Second Address | Rifle, CO 81650-2320 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2007 |
Last Update Date | 18/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U45194 | (02) | CO |