Provider Demographics
NPI:1487430914
Name:SMALLWOOD EYE ASSOCIATES, LLC
Entity type:Organization
Organization Name:SMALLWOOD EYE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDMUND
Authorized Official - Middle Name:CONNOR
Authorized Official - Last Name:SMALLWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:614-557-6774
Mailing Address - Street 1:78 MILL ST
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-3012
Mailing Address - Country:US
Mailing Address - Phone:614-337-1015
Mailing Address - Fax:614-337-1029
Practice Address - Street 1:78 MILL ST
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-3012
Practice Address - Country:US
Practice Address - Phone:614-337-1015
Practice Address - Fax:614-337-1029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty