Individual
CHARLES D SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1327 TROUP HWY, TYLER, TX 75701-4443
(903) 531-4733
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6450
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
7613T
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
216828801
—
TX
01
—
75-2616977-028
TRICARE
TX
01
—
752616977-021
TRICARE
TX
01
—
82831Q
BCBS
TX
01
—
TIN PLUS 015
TRICARE JV LOCATION
TX
Enumeration date
08/04/2010
Last updated
08/21/2023
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