Provider Demographics
NPI:1942550256
Name:GARY L SMITH OD PC
Entity Type:Organization
Organization Name:GARY L SMITH OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:OD, PC
Authorized Official - Phone:706-232-6767
Mailing Address - Street 1:1013 N 5TH AVE NE STE 4
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-2664
Mailing Address - Country:US
Mailing Address - Phone:706-232-6767
Mailing Address - Fax:706-291-4677
Practice Address - Street 1:1013 N 5TH AVE NE STE 4
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-2664
Practice Address - Country:US
Practice Address - Phone:706-232-6767
Practice Address - Fax:706-291-4677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-13
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT000687152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty