Provider Demographics
NPI:1922336395
Name:MARTHA D. SMYRE OD
Entity Type:Organization
Organization Name:MARTHA D. SMYRE OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:D
Authorized Official - Last Name:SMYRE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:704-455-5109
Mailing Address - Street 1:6493 MOREHEAD RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-8487
Mailing Address - Country:US
Mailing Address - Phone:704-455-5109
Mailing Address - Fax:
Practice Address - Street 1:6493 MOREHEAD RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-8487
Practice Address - Country:US
Practice Address - Phone:704-455-5109
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-24
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0952152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCT64819Medicare UPIN
NC0423540001Medicare NSC