Provider Demographics
NPI:1881675387
Name:SMITH, JULIE (OD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
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 1:301 S NORTON AVE
Mailing Address - Street 2:
Mailing Address - City:SYLACAUGA
Mailing Address - State:AL
Mailing Address - Zip Code:35150-3433
Mailing Address - Country:US
Mailing Address - Phone:256-207-1277
Mailing Address - Fax:256-207-1257
Practice Address - Street 1:301 S NORTON AVE
Practice Address - Street 2:
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150-3433
Practice Address - Country:US
Practice Address - Phone:256-207-1277
Practice Address - Fax:256-207-1257
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-856-TA-421152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL011810OtherNVA
AL2210393OtherUNITED HEALTH CARE
AL23173OtherSPECTERA
AL51503897OtherBLUE CROSS BLUE SHIELD
AL2562071277OtherVSP
AL2562071277OtherVSP