Provider Demographics
NPI:1649591082
Name:SMOOT EYE CARE, LLC
Entity Type:Organization
Organization Name:SMOOT EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SMOOT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-583-9203
Mailing Address - Street 1:1515 K ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421-3723
Mailing Address - Country:US
Mailing Address - Phone:812-675-4199
Mailing Address - Fax:812-675-0301
Practice Address - Street 1:1515 K ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-3723
Practice Address - Country:US
Practice Address - Phone:812-675-4199
Practice Address - Fax:812-675-0301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-21
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003555A152W00000X, 152WP0200X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200985290AMedicaid
INM100028118Medicare PIN