Healthcare Provider Details

I. General information

NPI: 1164187274
Provider Name (Legal Business Name): CHRIS A. SMILEY, O.D. AND ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2021
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3814 BROADWAY
GROVE CITY OH
43123-2234
US

IV. Provider business mailing address

3814 BROADWAY
GROVE CITY OH
43123-2234
US

V. Phone/Fax

Practice location:
  • Phone: 614-871-2080
  • Fax:
Mailing address:
  • Phone: 614-871-2080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: CHRIS A SMILEY
Title or Position: MANAGING MEMBER
Credential:
Phone: 614-880-2020