Provider Demographics
NPI:1902215551
Name:ELVEN C SMITH III
Entity Type:Organization
Organization Name:ELVEN C SMITH III
Other - Org Name:SMITH OPTOMETRIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELVEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:910-995-1110
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:HAMLET
Mailing Address - State:NC
Mailing Address - Zip Code:28345-0009
Mailing Address - Country:US
Mailing Address - Phone:910-995-1110
Mailing Address - Fax:910-582-2030
Practice Address - Street 1:720 E US HIGHWAY 74
Practice Address - Street 2:SUITE A
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-7206
Practice Address - Country:US
Practice Address - Phone:910-995-1110
Practice Address - Fax:910-582-2030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1267152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC246534HMedicare UPIN