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General NPI Number Information
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NPI Number | 1114562345
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Entity Type | Organization
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Legal Business Name | DR CHRISTOPHER D SMITH & ASSOCIATES LLC
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Dates
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Enumeration Date | 11/12/2019
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Last Update Date | 11/12/2019
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Provider Practice Location Address
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Address Line | 2665 MONROE RD STE 100
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City | DE PERE
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State | WI
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Zip | 54115-9287
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Country | US
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Telephone | 920-562-7383
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Fax |
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Provider Business Mailing Address
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Address Line | 3397 CARTER LN
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City | DE PERE
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State | WI
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Zip | 54115-8777
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Country | US
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Telephone | 920-562-7383
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHRISTOPHER DAVID SMITH
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Credential | OD
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Telephone | 920-562-7383
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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