Alan Charles Smith, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

628 Issued in MS

Practice address

1228 Goodman Rd E Ste 1
Southaven, MS 38671-9540

Phone

(662) 349-8838

Fax

(662) 349-8875

NPI assigned

Oct 24, 2006

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Desoto Family Vision PLLC

  • Optometrist
  • Southaven, MS
  • NPI 1679348924
  NPD (past)

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208476800000",
    "number": "1235213687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1228 GOODMAN RD E STE 1",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386719540",
            "telephone_number": "662-349-8838",
            "fax_number": "662-349-8875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1228 GOODMAN RD E STE 1",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386719540",
            "telephone_number": "662-349-8838",
            "fax_number": "662-349-8875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "ALAN",
        "middle_name": "CHARLES",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-24",
        "last_updated": "2008-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MS",
            "license": "628",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00087025",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tylar Skinner, RBT
• Sleep Diagnostics, LLC
• Sleep Management Clinic, LLC
• Sleep Unlimited Inc
• Audrey Lynne Smart, M.S., SLP
• Alison Edge Smith, MSN, PMHNP
• Catherine Ruth Smith, APN
• Chaniqua Dominique Smith, PMHNP-BC
• Edward L Smith Sr.
• Gabrielle Smith, HIS

• Optometrist in Southaven, MS
• Providers in Southaven, MS by specialty
• Optometrist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.