Provider Demographics
NPI:1568009553
Name:NICHOLAS KING-SMITH O.D., INC.
Entity Type:Organization
Organization Name:NICHOLAS KING-SMITH O.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KING-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:330-317-1728
Mailing Address - Street 1:1649 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-2148
Mailing Address - Country:US
Mailing Address - Phone:330-317-1728
Mailing Address - Fax:
Practice Address - Street 1:5144 MORSE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43230-1360
Practice Address - Country:US
Practice Address - Phone:330-317-1728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty