Provider Demographics
NPI:1871797399
Name:SMITH, LAURENCE P (OD)
Entity type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:P
Last Name:SMITH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:SAUGERTIES
Mailing Address - State:NY
Mailing Address - Zip Code:12477-1132
Mailing Address - Country:US
Mailing Address - Phone:845-246-7593
Mailing Address - Fax:
Practice Address - Street 1:1300 ULSTER AVE
Practice Address - Street 2:LENSCRAFTERS HUDSON VALLEY MALL
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-1501
Practice Address - Country:US
Practice Address - Phone:845-336-5878
Practice Address - Fax:845-336-5890
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT003137-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU54960Medicare UPIN
NYDD6781Medicare ID - Type Unspecified