Provider Demographics
NPI:1720241029
Name:SMITH-HAYES OPTICAL SERVICE, INC
Entity Type:Organization
Organization Name:SMITH-HAYES OPTICAL SERVICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:EMERY
Authorized Official - Middle Name:MACK
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-833-3261
Mailing Address - Street 1:229 DOWLEN RD
Mailing Address - Street 2:SUITE 4A
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-5919
Mailing Address - Country:US
Mailing Address - Phone:409-833-3261
Mailing Address - Fax:409-866-6849
Practice Address - Street 1:229 DOWLEN RD
Practice Address - Street 2:SUITE 4A
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-5919
Practice Address - Country:US
Practice Address - Phone:409-833-3261
Practice Address - Fax:409-866-6849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-07
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDR1478332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0873990001Medicare NSC