Provider Demographics
NPI:1679675334
Name:SMITH, CHAD S (OD)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:S
Last Name:SMITH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1100 SOUTHFIELD DR STE 1370
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-4300
Mailing Address - Country:US
Mailing Address - Phone:317-837-5566
Mailing Address - Fax:317-837-5580
Practice Address - Street 1:8244 E US HIGHWAY 36 STE 1270
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-9621
Practice Address - Country:US
Practice Address - Phone:317-272-4242
Practice Address - Fax:317-272-6640
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002790152W00000X
IL046008981152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0279612703Medicare ID - Type Unspecified
U67554Medicare UPIN