Provider Demographics
NPI:1972259687
Name:TODD SMITH & ASSOCIATES GA PC
Entity Type:Organization
Organization Name:TODD SMITH & ASSOCIATES GA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:FREEMAN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:SR
Authorized Official - Credentials:OD
Authorized Official - Phone:267-738-7702
Mailing Address - Street 1:717 S COLUMBUS BLVD UNIT 512
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-3508
Mailing Address - Country:US
Mailing Address - Phone:267-738-7702
Mailing Address - Fax:
Practice Address - Street 1:4104 LAVISTA RD STE A
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-5347
Practice Address - Country:US
Practice Address - Phone:770-493-3995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty