Provider Demographics
NPI:1184823593
Name:T H SMITH OD AND THOMAS K SMITH OD PC
Entity Type:Organization
Organization Name:T H SMITH OD AND THOMAS K SMITH OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:T
Authorized Official - Middle Name:K
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:731-352-2020
Mailing Address - Street 1:592 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MC KENZIE
Mailing Address - State:TN
Mailing Address - Zip Code:38201-1707
Mailing Address - Country:US
Mailing Address - Phone:731-352-2020
Mailing Address - Fax:731-352-3314
Practice Address - Street 1:592 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MCKENZIE
Practice Address - State:TN
Practice Address - Zip Code:38201-0001
Practice Address - Country:US
Practice Address - Phone:731-352-2020
Practice Address - Fax:731-352-3314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0403080001Medicare NSC
TN3594773Medicare PIN
TNU25477Medicare UPIN