Provider Demographics
NPI:1255125951
Name:SMOCK, JODI (LDO)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:SMOCK
Suffix:
Gender:
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10048 CHARLOTTE HWY
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29707-7135
Mailing Address - Country:US
Mailing Address - Phone:803-548-6622
Mailing Address - Fax:
Practice Address - Street 1:10048 CHARLOTTE HWY
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29707-7135
Practice Address - Country:US
Practice Address - Phone:803-548-6622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC985156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician