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NPI Code Detail

MEDICARE: DR. KEISHA CHERMISE SMITH O.D.

MEDICARE: DR. KEISHA CHERMISE SMITH 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
1152W00000XOptometrist1966NC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2180005599JOTHERNCRR MEDICARE INDIVIDUAL #

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3093TTOTHERNCBCBS PROV #

General Provider Information

NPI Number : 1821046483
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KEISHA CHERMISE SMITH O.D.
Provider Business Mailing Address
First Line : 5709 HIGH POINT RD
Second Line : SUITE 103
City : GREENSBORO
State : NC
Zip : 27407-7043
Country : US
Telephone Number : 336-856-8711
Fax Number : 336-856-0498
Provider Business Practice Location Address
First Line : 5709 HIGH POINT RD
Second Line : SUITE 103
City : GREENSBORO
State : NC
Zip : 27407-7043
Country : US
Telephone Number : 336-856-8711
Fax Number : 336-856-0498
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2006
Last Update Date : 01/05/2009

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