Provider Demographics
NPI:1477516987
Name:SMITH, THERON C (OD)
Entity Type:Individual
Prefix:DR
First Name:THERON
Middle Name:C
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 1:1014 W POINSETT ST
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-1315
Mailing Address - Country:US
Mailing Address - Phone:864-877-4731
Mailing Address - Fax:864-877-6320
Practice Address - Street 1:1014 W POINSETT ST
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-1315
Practice Address - Country:US
Practice Address - Phone:864-877-4731
Practice Address - Fax:864-877-6320
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC556152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC410014024OtherRAILROAD MEDICARE
SCD05563Medicaid
SC4397085OtherAETNA
NC8909844Medicaid
SCD05563Medicaid
SCT241733046Medicare PIN
SC410014024OtherRAILROAD MEDICARE