Provider Demographics
NPI:1558728154
Name:KRISTINA H. SMITH OD PLLC
Entity Type:Organization
Organization Name:KRISTINA H. SMITH OD PLLC
Other - Org Name:NORTHGATE VISION ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:HIXSON
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:423-618-0287
Mailing Address - Street 1:272 COTTONPORT RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37321-5100
Mailing Address - Country:US
Mailing Address - Phone:423-618-0287
Mailing Address - Fax:
Practice Address - Street 1:314 NORTHGATE MALL
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37415-6922
Practice Address - Country:US
Practice Address - Phone:423-875-3060
Practice Address - Fax:423-877-2714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-27
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN3141152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty