Provider Demographics
NPI:1255933669
Name:SMITH, TRISHA MARIE (OD)
Entity type:Individual
Prefix:
First Name:TRISHA
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 SE 9TH LN UNIT 21
Mailing Address - Street 2:
Mailing Address - City:GRIMES
Mailing Address - State:IA
Mailing Address - Zip Code:50111-5193
Mailing Address - Country:US
Mailing Address - Phone:641-330-2465
Mailing Address - Fax:
Practice Address - Street 1:1313 2ND ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:IA
Practice Address - Zip Code:50220-1511
Practice Address - Country:US
Practice Address - Phone:515-465-4203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA101054152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist