Provider Demographics
NPI:1679299283
Name:DR BOBBY DARRELL SMITH II OD PROFESSIONAL OPTOMETRIC CORPORATION
Entity type:Organization
Organization Name:DR BOBBY DARRELL SMITH II OD PROFESSIONAL OPTOMETRIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:DARRELL
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:II
Authorized Official - Credentials:OD
Authorized Official - Phone:949-290-2286
Mailing Address - Street 1:925 BLOSSOM HILL RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-1230
Mailing Address - Country:US
Mailing Address - Phone:415-531-0070
Mailing Address - Fax:
Practice Address - Street 1:925 BLOSSOM HILL RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-1230
Practice Address - Country:US
Practice Address - Phone:408-284-0117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-14
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty