Organization
BRADFORD D SMITH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRADFORD D SMITH OD (OWNER)
(207) 623-2020
Entity
Organization
Contact information
Practice address
15 WESTERN AVE, SUITE 1, AUGUSTA, ME 04330-7340
(207) 623-2020
(207) 623-1399
Mailing address
15 WESTERN AVE, SUITE 1, AUGUSTA, ME 04330-7340
(207) 623-2020
(207) 623-1399
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT-693
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09Z002183
FED/BC
—
01
—
2119511
AETNA
—
01
—
MNT 692
HARVARD PILGRIM
ME
01
—
PR92498370001
CIGNA
ME
Enumeration date
09/16/2006
Last updated
08/22/2020
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