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General NPI Number Information
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NPI Number | 1366730905
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Entity Type | Organization
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Legal Business Name | CHRISTOPHER A SMITH OD PA
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Dates
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Enumeration Date | 07/18/2011
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Last Update Date | 08/09/2011
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Provider Practice Location Address
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Address Line | 2422 W CENTRAL AVE SUITE C
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City | EL DORADO
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State | KS
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Zip | 67042-3239
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Country | US
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Telephone | 316-452-5999
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Fax |
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Provider Business Mailing Address
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Address Line | 8501 W CANDLEWOOD ST
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City | WICHITA
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State | KS
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Zip | 67205-8617
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Country | US
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Telephone | 316-708-9992
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. CHRISTOPHER ALLEN SMITH
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Credential | O.D.
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Telephone | 316-708-9992
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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 | 1826
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License Number State | KS
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