Provider Demographics
NPI:1538151154
Name:SMITH, THOMAS K (OD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:K
Last Name:SMITH
Suffix:
Gender:M
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:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:MC KENZIE
Mailing Address - State:TN
Mailing Address - Zip Code:38201-0280
Mailing Address - Country:US
Mailing Address - Phone:731-352-2020
Mailing Address - Fax:731-352-3314
Practice Address - Street 1:592 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MC KENZIE
Practice Address - State:TN
Practice Address - Zip Code:38201-0001
Practice Address - Country:US
Practice Address - Phone:731-352-2020
Practice Address - Fax:731-352-3314
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN0623152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U25477Medicare UPIN
TN3594773Medicare PIN