MEDICARE: KIRK L SMICK O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPT000737	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	406540201	OTHER	GA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023002540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRK L SMICK O.D.

Provider Business Mailing Address
First Line	:	1000 CORPORATE CENTER DRIVE
Second Line	:	STE 100
City	:	MORROW
State	:	GA
Zip	:	30260-4180
Country	:	US
Telephone Number	:	770-968-8888
Fax Number	:	770-960-2473

Provider Business Practice Location Address
First Line	:	1000 CORPORATE CENTER DRIVE
Second Line	:	SUITE 100
City	:	MORROW
State	:	GA
Zip	:	30260-4180
Country	:	US
Telephone Number	:	770-968-8888
Fax Number	:	770-960-2473

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	11/12/2008

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Directions to “ KIRK L SMICK O.D.” Practice Location

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