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General NPI Number Information
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NPI Number | 1164585758
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Entity Type | Organization
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Legal Business Name | FREDERICK EYE CARE PLLC
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 04/19/2011
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Provider Practice Location Address
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Address Line | 104 W GRAND AVE
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City | FREDERICK
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State | OK
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Zip | 73542-5436
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Country | US
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Telephone | 580-335-2020
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Fax | 580-335-7008
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Provider Business Mailing Address
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Address Line | 104 W GRAND AVE
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City | FREDERICK
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State | OK
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Zip | 73542-5436
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Country | US
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Telephone | 580-335-2020
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Fax | 580-335-7008
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Authorized Official
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Title or Position | OWNER
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Name | DR. JIMMY D SMART
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Credential | O.D.
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Telephone | 580-335-2020
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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 | 2471
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License Number State | OK
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