Provider Demographics
NPI:1023320504
Name:SMITH, BOBBY DARRELL II (OD)
Entity type:Individual
Prefix:DR
First Name:BOBBY
Middle Name:DARRELL
Last Name:SMITH
Suffix:II
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 VIA MURCIA
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-3859
Mailing Address - Country:US
Mailing Address - Phone:492-902-2869
Mailing Address - Fax:
Practice Address - Street 1:200 S WELLS RD STE 225
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93004-1382
Practice Address - Country:US
Practice Address - Phone:805-659-0250
Practice Address - Fax:805-659-9275
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13941152W00000X
GA0002729152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist