Healthcare Provider Details

I. General information

NPI: 1578055943
Provider Name (Legal Business Name): ASHLEY BECKING SMITH OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2018
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 LANGFORD RD
BLYTHEWOOD SC
29016-8648
US

IV. Provider business mailing address

1716 UNIVERSITY BLVD G090A
BIRMINGHAM AL
35294-0010
US

V. Phone/Fax

Practice location:
  • Phone: 803-714-1116
  • Fax:
Mailing address:
  • Phone: 205-975-2020
  • Fax: 205-934-6755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2106
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: