Provider Demographics
NPI:1750380796
Name:SMITH, HEATHER C (OD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:C
Last Name:SMITH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 E WT HARRIS BLVD
Mailing Address - Street 2:SUITE H
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-4104
Mailing Address - Country:US
Mailing Address - Phone:704-549-4523
Mailing Address - Fax:704-549-0606
Practice Address - Street 1:1001 E WT HARRIS BLVD
Practice Address - Street 2:SUITE H
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-4104
Practice Address - Country:US
Practice Address - Phone:704-549-4523
Practice Address - Fax:704-549-0606
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1651152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC800127OtherCOMMUNITY EYE CARE
NC800127OtherPARTNERS
NC093TKOtherBCBSNC
NC5900620Medicaid
NCU64440Medicare UPIN
NC5900620Medicaid