Jeffrey E Smith, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

1554 Issued in MN

Practice address

13855 Round Lake Blvd NW
Andover, MN 55304-3664

Phone

(763) 421-0141

Fax

(763) 421-0334

NPI assigned

Dec 8, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 6

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Physical Therapy Consultants, Inc.

  dba Ham Lake Physical Therapy

  • Physical Therapy Clinic/Center
  • Ham Lake, MN
  • NPI 1366460719
  NPD (past)

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

{
    "created_epoch": "1165536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1952461352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13855 ROUND LAKE BLVD NW",
            "city": "ANDOVER",
            "state": "MN",
            "postal_code": "553043664",
            "telephone_number": "763-421-0141",
            "fax_number": "763-421-0334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13855 ROUND LAKE BLVD NW",
            "city": "ANDOVER",
            "state": "MN",
            "postal_code": "553043664",
            "telephone_number": "763-421-0141",
            "fax_number": "763-421-0334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JEFFREY",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "1554",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "114915",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "56582330",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERREDONE",
            "identifier": "747001",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "16125",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "59780AN",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "2215383",
            "state": "FM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Leah Sherman, OTR/L
• Holly Shilling, DPT
• Britney Rose Silva
• Hawa Dekontee Sirleaf-Harris
• Courtney Jo Smith, PHARMD
• Jodi Ann Smith, M.S., LMFT
• Joshua Smith, DPT
• Tamara Smith, D.D.S., M.S.D
• Hannah Smoker, DPT
• Roman P Smulka, MD

• Optometrist in Andover, MN
• Providers in Andover, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.

Verify at the official NPI Registry.