Active NPI
Jeffery Smith, OD
- Optometrist
- Milwaukee, WI
National Provider Identifier
1366508285
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1980-035
- Practice address
- 5530 N Port Washington Rd
Milwaukee, WI 53217-4920 - Phone
- (414) 332-1114
- Fax
- (414) 332-5169
- NPI assigned
- Dec 28, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1980-035 | WI | Primary |
Addresses
Primary practice location
5530 N Port Washington Rd
Milwaukee, WI 53217-4920
Mailing address
11103 West Ave
Suite 6
San Antonio, TX 78213-1370
Phone (210) 524-6663
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 38575900 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1980-035 | WI | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Stein Optical Inc. | Optometrist | Past | Accepting new patients |
| Visionworks, Inc. | Optometrist | Past | Accepting new patients |
| Stein Optical Inc | Past | Accepting new patients | |
| Visionworks, Inc | Past | Accepting new patients |
Organizations & group practices 4
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.
-
- Eyewear Supplier
- Milwaukee, WI
- NPI 1417038423
-
- Optometrist
- Milwaukee, WI
- NPI 1801829551
-
- Optometrist
- Shorewood, WI
- NPI 1154699445
-
- Eyewear Supplier
- Simpsonville, SC
- NPI 1699571166
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167264000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1366508285",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11103 WEST AVE",
"address_2": "SUITE 6",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782131370",
"telephone_number": "210-524-6663",
"fax_number": "210-524-6587"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5530 N PORT WASHINGTON RD",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532174920",
"telephone_number": "414-332-1114",
"fax_number": "414-332-5169"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "JEFFERY",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-28",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "WI",
"license": "1980-035",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "38575900",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.