Provider Demographics
NPI:1821046483
Name:SMITH, KEISHA CHERMISE (OD)
Entity Type:Individual
Prefix:DR
First Name:KEISHA
Middle Name:CHERMISE
Last Name:SMITH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5709 HIGH POINT RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-7043
Mailing Address - Country:US
Mailing Address - Phone:336-856-8711
Mailing Address - Fax:336-856-0498
Practice Address - Street 1:5709 HIGH POINT RD
Practice Address - Street 2:SUITE 103
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-7043
Practice Address - Country:US
Practice Address - Phone:336-856-8711
Practice Address - Fax:336-856-0498
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1966152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901172Medicaid
NC180005599JOtherRR MEDICARE INDIVIDUAL #
NC093TTOtherBCBS PROV #
NC093TTOtherBCBS PROV #
NC2473709AMedicare ID - Type Unspecified
NC2473709FMedicare ID - Type Unspecified
NC2473709Medicare ID - Type Unspecified
NC2473709CMedicare ID - Type Unspecified
NC5901172Medicaid
V05663Medicare UPIN
NC2473709DMedicare ID - Type Unspecified