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General NPI Number Information
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NPI Number | 1952472904
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Entity Type | Organization
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Legal Business Name | SMITH OPTICAL COMPANY
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 02/13/2008
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Provider Practice Location Address
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Address Line | 730 FAIRVIEW AVENUE SUITE B1A
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City | BOWLING GREEN
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State | KY
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Zip | 42101-2367
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Country | US
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Telephone | 270-842-5575
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Fax | 270-842-5575
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Provider Business Mailing Address
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Address Line | 730 FAIRVIEW AVENUE SUITE B1A
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City | BOWLING GREEN
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State | KY
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Zip | 42101-2354
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Country | US
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Telephone | 270-842-5575
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Fax | 270-842-5575
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CHARLES B SMITH
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Credential | OPTICIAN
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Telephone | 270-842-5575
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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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