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General NPI Number Information
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NPI Number | 1235213687
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Entity Type | Individual
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Provider Name | ALAN CHARLES SMITH O.D.
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Gender | Male
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 04/18/2008
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Provider Practice Location Address
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Address Line | 1228 GOODMAN RD E STE 1
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City | SOUTHAVEN
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State | MS
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Zip | 38671-9540
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Country | US
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Telephone | 662-349-8838
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Fax | 662-349-8875
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Provider Business Mailing Address
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Address Line | 1228 GOODMAN RD E STE 1
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City | SOUTHAVEN
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State | MS
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Zip | 38671-9540
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Country | US
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Telephone | 662-349-8838
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Fax | 662-349-8875
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 628
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License Number State | MS
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