Individual
DR. MARK P SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
211 NORTH WHITWORTH AVE, BROOKHAVEN, MS 39601
(601) 833-4431
(601) 833-1007
Mailing address
211 NORTH WHITWORTH AVE, BROOKHAVEN, MS 39601
(601) 833-4431
(601) 833-1007
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
449
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09125722
—
MS
01
—
512G700288
MEDICARE PTAN
MS
Enumeration date
10/04/2006
Last updated
09/20/2012
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