Provider Demographics
NPI:1184674590
Name:SMOTHERS, JASON LOWELL (OD)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:LOWELL
Last Name:SMOTHERS
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:PO BOX 110
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:TN
Mailing Address - Zip Code:38337-0110
Mailing Address - Country:US
Mailing Address - Phone:731-784-4058
Mailing Address - Fax:731-772-2604
Practice Address - Street 1:1100 S DUPREE AVE
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38012
Practice Address - Country:US
Practice Address - Phone:731-772-0101
Practice Address - Fax:731-772-2604
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN17651795152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN11230090OtherCAQH
TNQ020350Medicaid
TN3941117Medicaid