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General NPI Number Information
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NPI Number | 1750768073
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Entity Type | Organization
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Legal Business Name | EYEXAM OF PEACHTREE CITY PC
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Dates
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Enumeration Date | 05/06/2015
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Last Update Date | 05/06/2015
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Provider Practice Location Address
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Address Line | 407 CITY CIR STE 1600
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-3125
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Country | US
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Telephone | 770-487-8013
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Fax |
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Provider Business Mailing Address
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Address Line | 407 CITY CIR STE 1600
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-3125
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST/PRESIDENT
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Name | DR. BOBBY DARRELL SMITH II
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Credential | O.D.
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Telephone | 770-487-8013
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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 | OPT002729
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License Number State | GA
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