Healthcare Provider Details

I. General information

NPI: 1063817229
Provider Name (Legal Business Name): SMITH EYE ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2014
Last Update Date: 10/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 CITY CIR SUITE 1600
PEACHTREE CITY GA
30269-3125
US

IV. Provider business mailing address

407 CITY CIR SUITE 1600
PEACHTREE CITY GA
30269-3125
US

V. Phone/Fax

Practice location:
  • Phone: 770-487-8013
  • Fax: 770-487-8365
Mailing address:
  • Phone: 770-487-8013
  • Fax: 770-487-8365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT002729
License Number StateGA

VIII. Authorized Official

Name: DR. BOBBY DARRELL SMITH II
Title or Position: OWNER/OPTOMETRIST
Credential: O.D.
Phone: 770-487-8013