Provider Demographics
NPI:1144223983
Name:SMOTHERS-CHAMPLEY, DEBRA (OD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:
Last Name:SMOTHERS-CHAMPLEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 W SPRINGFIELD RD
Mailing Address - Street 2:
Mailing Address - City:TAYLORVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62568-1213
Mailing Address - Country:US
Mailing Address - Phone:217-824-4991
Mailing Address - Fax:217-824-5414
Practice Address - Street 1:900 W SPRINGFIELD RD
Practice Address - Street 2:
Practice Address - City:TAYLORVILLE
Practice Address - State:IL
Practice Address - Zip Code:62568-1213
Practice Address - Country:US
Practice Address - Phone:217-824-4991
Practice Address - Fax:217-824-5414
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL37898Medicare ID - Type Unspecified
ILU57444Medicare UPIN