Provider Demographics
NPI:1366405771
Name:SMITH, ROSALIND O (OD)
Entity type:Individual
Prefix:DR
First Name:ROSALIND
Middle Name:O
Last Name:SMITH
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 1:1014 W POINSETT ST
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-1315
Mailing Address - Country:US
Mailing Address - Phone:864-877-4731
Mailing Address - Fax:864-877-6320
Practice Address - Street 1:1014 W POINSETT ST
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-1315
Practice Address - Country:US
Practice Address - Phone:864-877-4731
Practice Address - Fax:864-877-6320
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC587152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC09843OtherBCBS
NC09843OtherNC HEALTHCHOICE
SC326292Medicaid
SC570638440OtherBCBS
SCP00150662OtherRAILROAD MEDICARE
NC8909843Medicaid
SCP00150662OtherRAILROAD MEDICARE
SC0679250001Medicare NSC
SC326292Medicaid