Provider Demographics
NPI:1487624912
Name:SMITH, THOMAS W (OD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:W
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 1:601 HALTON RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-3403
Mailing Address - Country:US
Mailing Address - Phone:864-458-7956
Mailing Address - Fax:864-458-8390
Practice Address - Street 1:601 HALTON RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-3403
Practice Address - Country:US
Practice Address - Phone:864-458-7956
Practice Address - Fax:864-458-8390
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC646152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC410024409OtherMEDICARE RAILROAD
SC4489627OtherAETNA PROVIDER NUMBER
SC5812847002OtherCIGNA PROVIDER NUMBER
SCDA9938Medicaid
SCT246104594Medicare PIN
SC410024409OtherMEDICARE RAILROAD