Jervy William Smith, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT4957T Issued in CA

Practice address

6729 N Palm Ave Ste 104
Fresno, CA 93704-1076

Phone

(559) 650-3937

Fax

(559) 650-3927

NPI assigned

Dec 13, 2006

Last updated

Feb 22, 2010By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1266796800000",
    "number": "1174684930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6729 N PALM AVE STE 104",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937041076",
            "telephone_number": "559-650-3937",
            "fax_number": "559-650-3927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6729 N PALM AVE STE 104",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937041076",
            "telephone_number": "559-650-3937",
            "fax_number": "559-650-3927"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JERVY",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-13",
        "last_updated": "2010-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT4957T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0049570",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jared Smith, LCSW
• Jeanette Smith
• Jeffery Smith
• Jennifer Toler Smith, PSY.D.
• Jerry Smith, MD
• Juanita Rachel Smith, RN
• Julian Shane Smith, M.D.
• Juliana Janae Smith
• Justin Smith, OD
• Katherine T Smith, CDE/NP

• Optometrist in Fresno, CA
• Providers in Fresno, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.