Provider Demographics
NPI:1891276622
Name:SMITH, AMANDA NICOLE (OD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:NICOLE
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 1:726 N LOCUST AVE
Mailing Address - Street 2:STE 2D
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-2874
Mailing Address - Country:US
Mailing Address - Phone:931-762-7226
Mailing Address - Fax:931-762-1133
Practice Address - Street 1:726 N LOCUST AVE
Practice Address - Street 2:STE 2D
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-2874
Practice Address - Country:US
Practice Address - Phone:931-762-7226
Practice Address - Fax:931-762-1133
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-29
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3480152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist