Provider Demographics
NPI:1043433204
Name:CONSTANCE H SMITH MD PA
Entity Type:Organization
Organization Name:CONSTANCE H SMITH MD PA
Other - Org Name:SMITH EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:H
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-762-1942
Mailing Address - Street 1:529 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:BLYTHEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72315-1974
Mailing Address - Country:US
Mailing Address - Phone:870-762-1942
Mailing Address - Fax:870-763-0787
Practice Address - Street 1:529 N 10TH ST
Practice Address - Street 2:
Practice Address - City:BLYTHEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72315-1974
Practice Address - Country:US
Practice Address - Phone:870-762-1942
Practice Address - Fax:870-763-0787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR130197002Medicaid
AR130188001Medicaid
AR130188001Medicaid
AR130197002Medicaid