Provider Demographics
NPI:1952472904
Name:SMITH OPTICAL COMPANY
Entity Type:Organization
Organization Name:SMITH OPTICAL COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:B
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:270-842-5575
Mailing Address - Street 1:730 FAIRVIEW AVENUE
Mailing Address - Street 2:SUITE B1A
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-2354
Mailing Address - Country:US
Mailing Address - Phone:270-842-5575
Mailing Address - Fax:270-842-5575
Practice Address - Street 1:730 FAIRVIEW AVENUE
Practice Address - Street 2:SUITE B1A
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-2367
Practice Address - Country:US
Practice Address - Phone:270-842-5575
Practice Address - Fax:270-842-5575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0141690001OtherPIN
0141690001Medicare NSC