Provider Demographics
NPI:1629130745
Name:SMITH, WILLIAM VANCE JR (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:VANCE
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:W.
Other - Middle Name:VAN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:116 VIEWPOINT CIR
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-9702
Mailing Address - Country:US
Mailing Address - Phone:501-620-4300
Mailing Address - Fax:501-624-2695
Practice Address - Street 1:1601 ALBERT PIKE RD
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-4020
Practice Address - Country:US
Practice Address - Phone:501-620-4300
Practice Address - Fax:501-624-2695
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2180152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR48943Medicare ID - Type UnspecifiedOPTOMETRY