MEDICARE: SMITHFIELD EYE ASSOCIATES OPTOMETRY

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	1611	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	0907	OTHER	NC	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
2	09842	OTHER	NC	BCBS

General Provider Information

NPI Number	:	1851336465
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMITHFIELD EYE ASSOCIATES OPTOMETRY

Provider Business Mailing Address
First Line	:	1317 N BRIGHTLEAF BLVD
Second Line	:	SUITE D
City	:	SMITHFIELD
State	:	NC
Zip	:	27577-7267
Country	:	US
Telephone Number	:	919-934-2020
Fax Number	:	919-934-7370

Provider Business Practice Location Address
First Line	:	1317 N BRIGHTLEAF BLVD
Second Line	:	SUITE D
City	:	SMITHFIELD
State	:	NC
Zip	:	27577-7267
Country	:	US
Telephone Number	:	919-934-2020
Fax Number	:	919-934-7370

Authorized Official
Title or Position	:	OWNER DOCTOR
Name	:	DR. MICHAEL JOSEPH HAINES
Credential	:	OD
Telephone Number	:	919-934-2020

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	06/03/2013

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Directions to “SMITHFIELD EYE ASSOCIATES OPTOMETRY ” Practice Location

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