Basic Information
| Provider Information | |||||||||
| NPI: | 1104874627 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | # L-3549 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432600001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403639021 | ||||||||
| FaxNumber: | 7403837942 | ||||||||
| Practice Location | |||||||||
| Address1: | 6 LEXINGTON BLVD | ||||||||
| Address2: | |||||||||
| City: | DELAWARE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430151047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403633230 | ||||||||
| FaxNumber: | 7403687185 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2006 | ||||||||
| LastUpdateDate: | 10/07/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 350601885 | OH | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 0751002 | 01 | PALMETTO MEDICARE | OTHER | 180018458 | 01 | TRAVELERS MEDICARE | OTHER | 650180 | 01 | AETNA | OTHER | 000000118426 | 01 | OH | ANTHEM | OTHER | 353077 | 01 | SUBMITTER NO | OTHER | 0800476 | 01 | UHC | OTHER | 0974549 | 05 | OH | MEDICAID |