Healthcare Provider Details

I. General information

NPI: 1225913924
Provider Name (Legal Business Name): LYDIA SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2025
Last Update Date: 09/01/2025
Certification Date: 09/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 COLLEGE ST STE B
ATHENS AL
35611-2714
US

IV. Provider business mailing address

110 COLLEGE ST STE B
ATHENS AL
35611-2714
US

V. Phone/Fax

Practice location:
  • Phone: 256-233-2393
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberS-F58-TA-D81
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: