Provider Demographics
NPI:1215974548
Name:SMITH, ELVEN CONRAD III (OD)
Entity type:Individual
Prefix:DR
First Name:ELVEN
Middle Name:CONRAD
Last Name:SMITH
Suffix:III
Gender:M
Credentials:OD
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Mailing Address - Street 1:1502 E BROAD AVE
Mailing Address - Street 2:STE A
Mailing Address - City:ROCKINGHAM
Mailing Address - State:NC
Mailing Address - Zip Code:28379-4908
Mailing Address - Country:US
Mailing Address - Phone:910-997-7737
Mailing Address - Fax:910-997-7058
Practice Address - Street 1:720 E US HIGHWAY 74
Practice Address - Street 2:STE A
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-7524
Practice Address - Country:US
Practice Address - Phone:910-205-2020
Practice Address - Fax:910-582-2030
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2021-03-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC1267152WL0500X, 152W00000X
SC1182152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1182OtherLICENSE #
NC1267OtherLICENSE#
NC8909835Medicaid
NC1267OtherLICENSE #
NC246534GMedicare PIN