Provider Demographics
NPI:1164530374
Name:RONDA F SMITH
Entity Type:Organization
Organization Name:RONDA F SMITH
Other - Org Name:EYE DESIGNS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RONDA
Authorized Official - Middle Name:F
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DPO
Authorized Official - Phone:423-764-7630
Mailing Address - Street 1:308 RIDGEMONT ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-7132
Mailing Address - Country:US
Mailing Address - Phone:423-764-7630
Mailing Address - Fax:423-764-7630
Practice Address - Street 1:308 RIDGEMONT ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-7132
Practice Address - Country:US
Practice Address - Phone:423-764-7630
Practice Address - Fax:423-764-7630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPO976152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN=========OtherTAX ID