Organization Active NPI

Dr Ronald N Smith Optometrist Inc

  • Corneal and Contact Management Optometrist
  • Tyler, TX
National Provider Identifier
1174651731
Registry record updated May 20, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Corneal and Contact Management OptometristTaxonomy code 152WC0802X
Legal business name
DR RONALD N SMITH OPTOMETRIST INC
Practice address
2732 S Broadway Ave
Tyler, TX 75701-5412
Phone
(903) 597-9020
NPI assigned
Mar 2, 2007
Last updated
May 20, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2013

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

Authorized official

Name
Dr. Ronald N Smith, ODNPI 1215920111
Title
President
Phone
(903) 597-9020

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X
Corneal and Contact Management Optometrist 152WC0802X Primary

Addresses

Primary practice location

2732 S Broadway Ave
Tyler, TX 75701-5412

Mailing address

2732 S Broadway Ave
Tyler, TX 75701-5412
Phone (903) 597-9020

Other identifiers 2

IdentifierTypeStateIssuer
0025EXOtherTXGROUP NUMBER FOR BLUECROS
00014SOtherTXMEDICARE PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080414000154 TX Part B Supplier - Clinic/Group Practice 2860579976 Receives reassigned benefits from 2 practitioners
Practice locations: Tyler, TX

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D2116266Dr Ronald N Smith, Optometrist, Inc2732 S Broadway, Tyler, TX 75701Certificate of waiverJul 21, 2028

National Provider Directory

National Provider Directory

Locations

2732 S Broadway Ave
Tyler, TX 75701
Phone (903) 597-9020

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1172793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369008000000",
    "number": "1174651731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2732 S BROADWAY AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757015412",
            "telephone_number": "903-597-9020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2732 S BROADWAY AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757015412",
            "telephone_number": "903-597-9020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR RONALD N SMITH OPTOMETRIST INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-02",
        "last_updated": "2013-05-20",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "903-597-9020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NUMBER FOR BLUECROS",
            "identifier": "0025EX",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "00014S",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.