Wyatt Logan Smith, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

5226 Issued in MT

Practice address

580 N Meridian Rd
Kalispell, MT 59901-3532

Phone

(406) 755-5910

NPI assigned

Mar 29, 2024

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MT

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Pacific University - College of Optometry, 2024

Medicare assignment

May accept Medicare assignment

Group practices

Vision Clinic PLLCGroup PAC ID 2769474436, 5 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Vision Clinic PLLC

  • Optometrist
  • Kalispell, MT
  • NPI 1528240454
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1711670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723420800000",
    "number": "1316798135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "580 N MERIDIAN RD",
            "city": "KALISPELL",
            "state": "MT",
            "postal_code": "599013532",
            "telephone_number": "406-755-5910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "580 N MERIDIAN RD",
            "city": "KALISPELL",
            "state": "MT",
            "postal_code": "599013532",
            "telephone_number": "406-755-5910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "WYATT",
        "middle_name": "LOGAN",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-03-29",
        "last_updated": "2024-08-12",
        "certification_date": "2024-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MT",
            "license": "5226",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gordon Fredrick Smith II, MSPT
• Jesse Smith
• Judith Neal Smith, FNP
• Sheila R. Smith, LCPC
• Stanley R Smith, OD
• Smiths Food & Drug Centers Inc
• Douglas E Snyder, MPT
• Margaret Sommers, IBCLC
• Julie Ann Sonderegger, MSW
• Mark Jacob Sorensen, M.D.

• Optometrist in Kalispell, MT
• Providers in Kalispell, MT by specialty
• Optometrist in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2024; 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.
• 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.