Provider Demographics
NPI:1881850402
Name:SMITH, CHRISTOPHER ALLEN (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:ALLEN
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 1:8501 W CANDLEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-8617
Mailing Address - Country:US
Mailing Address - Phone:316-708-9992
Mailing Address - Fax:316-452-5624
Practice Address - Street 1:2422 W CENTRAL AVE
Practice Address - Street 2:SUITE C
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-3239
Practice Address - Country:US
Practice Address - Phone:316-452-5999
Practice Address - Fax:316-452-5624
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1826152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200579470CMedicaid