Ian Michael Smith, CPO

Primary specialty

ProsthetistTaxonomy code 224P00000X

License

CPO05333

Practice address

1516 Hudson St Ste 105
Longview, WA 98632-3046

Phone

(360) 423-6049

NPI assigned

Oct 19, 2023

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1697673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697673600000",
    "number": "1497537898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1441 NE 136TH AVE APT 284",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986845985",
            "telephone_number": "360-907-3341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1516 HUDSON ST STE 105",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986323046",
            "telephone_number": "360-423-6049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "IAN",
        "middle_name": "MICHAEL",
        "name_prefix": "Mr.",
        "credential": "CPO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-10-19",
        "last_updated": "2023-10-19",
        "certification_date": "2023-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "222Z00000X",
            "taxonomy_group": "",
            "desc": "Orthotist",
            "state": null,
            "license": "CPO05333",
            "primary": false
        },
        {
            "code": "224P00000X",
            "taxonomy_group": "",
            "desc": "Prosthetist",
            "state": null,
            "license": "CPO05333",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Smiles Dental Group, PC
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• Carolina Kato Smith, MD
• Emily A Smith, BS, R-AAC
• Fran J Smith, MSW
• Jessica K Smith
• Kimberly Denise Smith, CPC
• Kylah Archelle Smith
• Lyndsey Smith, DENTAL HYGIENIST
• Raquel Smith, BS, AAC

• Prosthetist in Longview, WA
• Providers in Longview, WA by specialty
• Prosthetist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2023; 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.