Individual
JOHN O. SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1201 S MAIN ST, HENNESSEY, OK 73742-1744
(405) 853-6800
(405) 853-6805
Mailing address
PO BOX 654, HENNESSEY, OK 73742-0654
(405) 853-6800
(405) 853-6805
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1014
OK
152WC0802X
Corneal and Contact Management Optometrist
1014
OK
152WL0500X
Low Vision Rehabilitation Optometrist
1014
OK
152WP0200X
Pediatric Optometrist
1014
OK
152WS0006X
Sports Vision Optometrist
1014
OK
152WV0400X
Vision Therapy Optometrist
1014
OK
152WX0102X
Occupational Vision Optometrist
1014
OK
332H00000X
Eyewear Supplier
1014
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
731129821001
BCBS PAYER ID
OK
Enumeration date
04/27/2006
Last updated
03/03/2008
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