Stacy R Smith MD PC

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

60248791205 Issued in UT

Legal business name

STACY R SMITH MD PC

Practice address

1548 E 4500 S
Ste 105
Salt Lake City, UT 84117-4209

Phone

(801) 424-3090

Fax

(801) 424-3091

NPI assigned

Jul 27, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Stacy R Smith, M.D.NPI 1639348899

Title

Physician

Phone

(801) 424-3090

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Stacy Ruth Smith, M.D.

  • Ophthalmology Physician
  • Salt Lake City, UT
  • NPI 1639348899
  Medicare reassignment Care Compare group NPD Authorized official
• Adam M Bowman, MD

  • Ophthalmology Physician
  • Salt Lake City, UT
  • NPI 1184846131
  Medicare reassignment Care Compare group NPD
• John B Fassio, MD

  • Ophthalmology Physician
  • Park City, UT
  • NPI 1689671638
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1343347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1368403200000",
    "number": "1003162058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1548 E 4500 S",
            "address_2": "STE 105",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841174209",
            "telephone_number": "801-424-3090",
            "fax_number": "801-424-3091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1548 E 4500 S",
            "address_2": "STE 105",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841174209",
            "telephone_number": "801-424-3090",
            "fax_number": "801-424-3091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STACY R SMITH MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-27",
        "last_updated": "2013-05-13",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "STACY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "801-424-3090",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "UT",
            "license": "60248791205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stacey Bank MD PC
• Stacey M. Francone, LCSW Inc.
• Alyssa Kay Stacey, R.D., C.D.
• Stacie Sears LLC (Black Dog Counseling LLC)
• Samantha Lee Stacks, NP
• Ryan Stadheim
• Bonnie Jean Stafford-Litton
• Breanna P. Stafford, MD
• Douglas Ray Stafford, LPC
• Leigha Stafford

• Ophthalmology Physician in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Ophthalmology Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.