Provider Demographics
NPI:1255993077
Name:ASHEIM SMITH, MARISA LYNN (OD)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:LYNN
Last Name:ASHEIM SMITH
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 31ST AVE SW STE E
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-2016
Mailing Address - Country:US
Mailing Address - Phone:701-857-6050
Mailing Address - Fax:
Practice Address - Street 1:1525 31ST AVE SW STE E
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-2016
Practice Address - Country:US
Practice Address - Phone:018-576-0507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2025-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3637152W00000X
NDND774152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist