Provider Demographics
NPI:1144218470
Name:SMITH, JOHN HAYES (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HAYES
Last Name:SMITH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11927 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-9356
Mailing Address - Country:US
Mailing Address - Phone:843-651-4200
Mailing Address - Fax:843-651-4200
Practice Address - Street 1:11927 PLAZA DR
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-9356
Practice Address - Country:US
Practice Address - Phone:843-651-4200
Practice Address - Fax:843-651-4200
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC785152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD07850Medicaid
SCD07850Medicaid
SCT78215Medicare UPIN