MEDICARE: EMMA C SMILEY OD

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	3827	TN
2	152W00000X	Optometrist	OPT.007160	OH
3	390200000X	Student in an Organized Health Care Education/Training Program
4	152W00000X	Optometrist	OEG004131	PA

General Provider Information

NPI Number	:	1316636699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMA C SMILEY OD

Provider Business Mailing Address
First Line	:	4401 PENN AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15224-1334
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3601 THE VANDERBILT CLINIC
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37232-0025
Country	:	US
Telephone Number	:	615-322-5000
Fax Number	:

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

Provider Enumeration Date	:	05/03/2023
Last Update Date	:	08/28/2024

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