Emmett Donald Smith, OD
Individual provider Active NPI Optometrist · Cleveland, MS
NPI 1104815992 · NPPES record last updated Dec 30, 2009
Key facts
- NPI
- 1104815992
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 546 (MS)
- Practice address
- 136 North St
Cleveland, MS 38732-2744 - Phone
- (662) 846-6641
- Fax
- (662) 846-6644
- NPI assigned
- Oct 14, 2005
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Southern College of Optometry, 1986
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
136 N St
Cleveland, MS 38732-2744
Phone (662) 846-6641
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 45 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100429000594 | MS | Practitioner - Optometry | 6406983006 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 546 | MS | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cleveland Eye Clinic PA | Optometrist | Current |
Accepting new patients |
Locations
136 North St
Cleveland, MS 38732
Phone (662) 846-6641
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 546 | MS | Yes |
Addresses
Primary practice location
136 North St
Cleveland, MS 38732-2744
Mailing address
PO Box 1108
Cleveland, MS 38732-1108
Phone (662) 846-6641
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 09957099 | Medicaid | MS |
Other providers in Cleveland, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 30, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.