Provider Demographics
NPI:1477741601
Name:SMITH VISION CENTER, OPTOMETRISTS LLC
Entity type:Organization
Organization Name:SMITH VISION CENTER, OPTOMETRISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:715-825-3974
Mailing Address - Street 1:1301 COUNTY ROAD G
Mailing Address - Street 2:
Mailing Address - City:MILLTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:54858-2915
Mailing Address - Country:US
Mailing Address - Phone:715-825-3974
Mailing Address - Fax:
Practice Address - Street 1:1301 COUNTY ROAD G
Practice Address - Street 2:
Practice Address - City:MILLTOWN
Practice Address - State:WI
Practice Address - Zip Code:54858-2915
Practice Address - Country:US
Practice Address - Phone:715-825-3974
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2729152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty