Basic Information
| Provider Information | |||||||||
| NPI: | 1538277330 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | LIONEL | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4313 I-49 SOUTH SERVICE RD. | ||||||||
| Address2: | |||||||||
| City: | OPELOUSAS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70570 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3379422024 | ||||||||
| FaxNumber: | 3379486216 | ||||||||
| Practice Location | |||||||||
| Address1: | 4313 I-49 SOUTH SERVICE RD. | ||||||||
| Address2: | |||||||||
| City: | OPELOUSAS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70570 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3379422024 | ||||||||
| FaxNumber: | 3379486216 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2006 | ||||||||
| LastUpdateDate: | 10/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 11657 | LA | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | 011657 | LA | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 1147877 | 05 | LA | MEDICAID |