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General NPI Number Information
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NPI Number | 1710391487
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Entity Type | Individual
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Provider Name | NICHOLAS KING-SMITH O.D.
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Gender | Male
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Dates
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Enumeration Date | 06/20/2014
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Last Update Date | 06/20/2014
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Provider Practice Location Address
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Address Line | 665 BRIARTHORN CRESCENT DR
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City | WADSWORTH
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State | OH
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Zip | 44281-7501
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Country | US
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Telephone | 330-336-9177
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Fax |
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Provider Business Mailing Address
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Address Line | 9397 LATTASBURG RD
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City | WEST SALEM
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State | OH
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Zip | 44287-9725
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Country | US
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Telephone | 330-317-1728
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Fax |
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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 | 6291
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License Number State | OH
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