Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OD00000787 | WA |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | MS1246897 | WA |
NPI | 1043362882 |
---|---|
Provider Name | Gerald W Smith |
First Address | Seattle, WA 98124-1584 |
Second Address | Redmond, WA 98052-5501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 16/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8100562 | (05) | WA |
U21975 | (02) | WA |