MEDICARE: JOHN W L SMITH 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	332H00000X	Eyewear Supplier	0658800001	SC

General Provider Information

NPI Number	:	1528242559
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN W L SMITH OD

Provider Business Mailing Address
First Line	:	531 GEORGIA AVE
Second Line	:
City	:	NORTH AUGUSTA
State	:	SC
Zip	:	29841-3701
Country	:	US
Telephone Number	:	803-279-5277
Fax Number	:	803-279-0699

Provider Business Practice Location Address
First Line	:	531 GEORGIA AVE
Second Line	:
City	:	NORTH AUGUSTA
State	:	SC
Zip	:	29841-3701
Country	:	US
Telephone Number	:	803-279-5277
Fax Number	:	803-279-0699

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. ANGIE PATTESON
Credential	:	OD
Telephone Number	:	803-279-5277

Provider Enumeration Date	:	12/27/2007
Last Update Date	:	01/27/2010

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