Individual
DR. GOLDEN THANE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
500 S UTAH AVE, IDAHO FALLS, ID 83402-3305
(208) 528-8643
Mailing address
500 S UTAH AVE, IDAHO FALLS, ID 83402-3305
(208) 528-8643
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
1040
NV
152W00000X
Optometrist
11319935-9934
UT
152W00000X
Optometrist
Primary
ODP-992
ID
Other
Enumeration date
08/31/2006
Last updated
09/27/2019
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