Provider Demographics
NPI:1851443956
Name:DRS STEVEN AND BRENDA SMOKE OD PC
Entity Type:Organization
Organization Name:DRS STEVEN AND BRENDA SMOKE OD PC
Other - Org Name:SMOKE FAMILY VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:D
Authorized Official - Last Name:SMOKE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:269-695-3434
Mailing Address - Street 1:400 E FRONT ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:BUCHANAN
Mailing Address - State:MI
Mailing Address - Zip Code:49107-1403
Mailing Address - Country:US
Mailing Address - Phone:269-695-3434
Mailing Address - Fax:269-695-2656
Practice Address - Street 1:400 E FRONT ST
Practice Address - Street 2:SUITE A
Practice Address - City:BUCHANAN
Practice Address - State:MI
Practice Address - Zip Code:49107-1403
Practice Address - Country:US
Practice Address - Phone:269-695-3434
Practice Address - Fax:269-695-2656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI04901003315152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900A100180OtherBCBS MI GROUP PIN
MIDD6283OtherRAILROAD MEDICARE
MI0238080001Medicare NSC
MI900A100180OtherBCBS MI GROUP PIN