Provider Demographics
NPI:1184634982
Name:SMITH, RHONDA FLETCHER (DPO)
Entity Type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:FLETCHER
Last Name:SMITH
Suffix:
Gender:F
Credentials:DPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN976152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist