Provider Demographics
NPI:1265480271
Name:SMITH, LAURA LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
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 430
Mailing Address - Street 2:
Mailing Address - City:LILLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27546-5621
Mailing Address - Country:US
Mailing Address - Phone:910-893-5711
Mailing Address - Fax:910-893-4805
Practice Address - Street 1:210 WEST IVEY STREET
Practice Address - Street 2:
Practice Address - City:LILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27546-5621
Practice Address - Country:US
Practice Address - Phone:910-893-5711
Practice Address - Fax:910-893-4805
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1468152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5916665Medicaid
NC8909713Medicaid
NCU35488Medicare UPIN
NC2484675AMedicare PIN
NC5916665Medicaid