Provider Demographics
NPI:1467070656
Name:AMANDA SMITH OPTOMETRY, PLLC
Entity Type:Organization
Organization Name:AMANDA SMITH OPTOMETRY, PLLC
Other - Org Name:ENVISION EYECARE AND EYEWEAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-762-7226
Mailing Address - Street 1:726 N LOCUST AVE STE 2D
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-2874
Mailing Address - Country:US
Mailing Address - Phone:931-762-7226
Mailing Address - Fax:931-762-1133
Practice Address - Street 1:726 N LOCUST AVE STE 2D
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-2874
Practice Address - Country:US
Practice Address - Phone:931-762-7226
Practice Address - Fax:931-762-1133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-14
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ058467Medicaid