Provider Demographics
NPI:1295060382
Name:BARBOT-SMITH, MEGAN ELISE (OD)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:ELISE
Last Name:BARBOT-SMITH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:ELISE
Other - Last Name:BARBOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1100 N BROADWAY STE 110
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58703-1349
Mailing Address - Country:US
Mailing Address - Phone:701-852-2020
Mailing Address - Fax:701-852-7853
Practice Address - Street 1:1100 N BROADWAY STE 110
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58703-1349
Practice Address - Country:US
Practice Address - Phone:701-852-2020
Practice Address - Fax:701-852-7853
Is Sole Proprietor?:No
Enumeration Date:2009-10-07
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3294152W00000X
WI3277-35152W00000X
ND697152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist