Provider Demographics
NPI:1467738609
Name:WILLIAM C SMITH II OD PC
Entity Type:Organization
Organization Name:WILLIAM C SMITH II OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:M
Authorized Official - Last Name:PERHAC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-893-1913
Mailing Address - Street 1:119 S ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-3701
Mailing Address - Country:US
Mailing Address - Phone:615-893-1913
Mailing Address - Fax:615-893-1917
Practice Address - Street 1:119 S ACADEMY ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-3701
Practice Address - Country:US
Practice Address - Phone:615-893-1913
Practice Address - Fax:615-893-1917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-02
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD0000000737152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2000958OtherBLUECROSS BLUESHIELD OF TN
TN7373989OtherCIGNA
TN2000958OtherTENNCARE SELECT
TN3594994Medicaid
TN3594994Medicaid
TN3594993Medicare PIN
2000958OtherBLUECROSS BLUESHIELD OF TN