Provider Demographics
NPI:1336848142
Name:SMITH, GRIFFIN (OD)
Entity Type:Individual
Prefix:DR
First Name:GRIFFIN
Middle Name:
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 1:1120 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:AR
Mailing Address - Zip Code:72104-5224
Mailing Address - Country:US
Mailing Address - Phone:501-332-2012
Mailing Address - Fax:501-332-8403
Practice Address - Street 1:1120 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:AR
Practice Address - Zip Code:72104-5224
Practice Address - Country:US
Practice Address - Phone:501-332-2012
Practice Address - Fax:501-332-8403
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2863152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist