Provider Demographics
NPI:1235146531
Name:SMITH, FRANKLIN NEAL (OD)
Entity Type:Individual
Prefix:DR
First Name:FRANKLIN
Middle Name:NEAL
Last Name:SMITH
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 1:4221 MAYFAIR ST
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-5757
Mailing Address - Country:US
Mailing Address - Phone:843-448-6630
Mailing Address - Fax:843-448-5567
Practice Address - Street 1:4221 MAYFAIR ST
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5757
Practice Address - Country:US
Practice Address - Phone:843-448-6630
Practice Address - Fax:843-448-5567
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC733152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD07339Medicaid
SCT24200Medicare UPIN
SCD07339Medicaid
SC180005274Medicare PIN
SC0645240001Medicare PIN