Provider Demographics
NPI:1538150396
Name:LOREN D SMITH OD INC
Entity type:Organization
Organization Name:LOREN D SMITH OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES/COO
Authorized Official - Prefix:DR
Authorized Official - First Name:LOREN
Authorized Official - Middle Name:DONNELL
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:OD (OCULUS DOCTOR)
Authorized Official - Phone:323-756-3937
Mailing Address - Street 1:11502 S VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90044-6522
Mailing Address - Country:US
Mailing Address - Phone:323-756-3937
Mailing Address - Fax:323-756-3938
Practice Address - Street 1:11502 S VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-6522
Practice Address - Country:US
Practice Address - Phone:323-756-3937
Practice Address - Fax:323-756-3938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA07354T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty