Provider Demographics
NPI:1063817229
Name:SMITH EYE ASSOCIATES, LLC
Entity type:Organization
Organization Name:SMITH EYE ASSOCIATES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:DARRELL
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:II
Authorized Official - Credentials:OD
Authorized Official - Phone:770-487-8013
Mailing Address - Street 1:407 CITY CIR
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-3125
Mailing Address - Country:US
Mailing Address - Phone:770-487-8013
Mailing Address - Fax:770-487-8365
Practice Address - Street 1:407 CITY CIR
Practice Address - Street 2:SUITE 1600
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-3125
Practice Address - Country:US
Practice Address - Phone:770-487-8013
Practice Address - Fax:770-487-8365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002729152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty