Provider Demographics
NPI:1841385929
Name:SMITH, ELISE HESSON (OD)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:HESSON
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 1:8244 E US HIGHWAY 36
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-9575
Mailing Address - Country:US
Mailing Address - Phone:317-272-2020
Mailing Address - Fax:317-272-6544
Practice Address - Street 1:8244 E US HIGHWAY 36
Practice Address - Street 2:SUITE 200
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-9575
Practice Address - Country:US
Practice Address - Phone:317-272-2020
Practice Address - Fax:317-272-6544
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002927B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN345490AMedicare ID - Type Unspecified