Provider Demographics
NPI:1942329396
Name:SMITH, RORY CLIFFORD (OD)
Entity Type:Individual
Prefix:DR
First Name:RORY
Middle Name:CLIFFORD
Last Name:SMITH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1655 W COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478-5207
Mailing Address - Country:US
Mailing Address - Phone:931-424-8223
Mailing Address - Fax:931-424-8172
Practice Address - Street 1:1655 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-5207
Practice Address - Country:US
Practice Address - Phone:931-424-8223
Practice Address - Fax:931-424-8172
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD2483152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU65431Medicare UPIN