Provider Demographics
NPI:1154341360
Name:SMYRE, MARTHA D (OD)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:D
Last Name:SMYRE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6493 MOREHEAD RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-8487
Mailing Address - Country:US
Mailing Address - Phone:704-455-5109
Mailing Address - Fax:704-455-5100
Practice Address - Street 1:6493 MOREHEAD RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-8487
Practice Address - Country:US
Practice Address - Phone:704-455-5109
Practice Address - Fax:704-455-5100
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0952152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC246271Medicare PIN
NC0423540001Medicare NSC
NCT64819Medicare UPIN