Provider Demographics
NPI:1083607279
Name:SMITH, JANNA SUZETTE (OD)
Entity Type:Individual
Prefix:
First Name:JANNA
Middle Name:SUZETTE
Last Name:SMITH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JANNA
Other - Middle Name:SUZETTE
Other - Last Name:ZBOZIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:110 MATHIS DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-2000
Mailing Address - Country:US
Mailing Address - Phone:615-446-8089
Mailing Address - Fax:615-441-3135
Practice Address - Street 1:110 MATHIS DRIVE
Practice Address - Street 2:SUITE 108
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055
Practice Address - Country:US
Practice Address - Phone:615-446-8089
Practice Address - Fax:615-441-3135
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2172152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1083607279OtherINDIVIDUAL NPI #
TN3944408Medicaid
TN2172OtherOD
TNMZ0726565OtherDEA
U85699Medicare UPIN
TN3944408Medicaid
TN2172OtherOD
MS05880890Medicare PIN