Provider Demographics
NPI:1073565099
Name:SMITH OPTOMETRIC EYE ASSOCIATES OF TRYON, PA
Entity Type:Organization
Organization Name:SMITH OPTOMETRIC EYE ASSOCIATES OF TRYON, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSALIND
Authorized Official - Middle Name:O
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:828-859-5821
Mailing Address - Street 1:PO BOX 1192
Mailing Address - Street 2:
Mailing Address - City:TRYON
Mailing Address - State:NC
Mailing Address - Zip Code:28782-1192
Mailing Address - Country:US
Mailing Address - Phone:828-859-5821
Mailing Address - Fax:828-859-5822
Practice Address - Street 1:30 NEW MARKET RD
Practice Address - Street 2:
Practice Address - City:TRYON
Practice Address - State:NC
Practice Address - Zip Code:28782-3688
Practice Address - Country:US
Practice Address - Phone:828-859-5821
Practice Address - Fax:828-859-5822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909844Medicaid
SCDAN982Medicaid
NC017WVOtherBCBS
NC8909843Medicaid
NC8909843Medicaid
NC8909844Medicaid
NCT24173Medicare UPIN