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General NPI Number Information
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NPI Number | 1932661758
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Entity Type | Organization
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Legal Business Name | MIWS, LLC
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Dates
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Enumeration Date | 04/01/2019
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Last Update Date | 04/01/2019
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Provider Practice Location Address
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Address Line | 1110 MARKET ST STE 113
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City | CHATTANOOGA
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State | TN
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Zip | 37402-2894
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Country | US
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Telephone | 423-541-3792
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Fax | 423-541-3793
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Provider Business Mailing Address
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Address Line | 600 JAMES ST
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City | ROSSVILLE
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State | GA
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Zip | 30741-2179
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Country | US
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Telephone | 423-883-5984
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Fax |
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Authorized Official
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Title or Position | OWNER/OPTICIAN
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Name | MR. MATTHEW R SMIT
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Credential | LDO
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Telephone | 423-883-5984
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number |
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License Number State |
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