Individual
DR. GARY LOCKE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1013 N 5TH AVE NE, SUITE 4, ROME, GA 30165-2664
(706) 232-6767
(706) 291-4677
Mailing address
1013 N 5TH AVE NE, ROME, GA 30165-2664
(706) 232-6767
(706) 291-4677
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
000687
GA
152WC0802X
Corneal and Contact Management Optometrist
000687
GA
152WL0500X
Low Vision Rehabilitation Optometrist
000687
GA
152WP0200X
Pediatric Optometrist
000687
GA
152WS0006X
Sports Vision Optometrist
000687
GA
152WV0400X
Vision Therapy Optometrist
000687
GA
152WX0102X
Occupational Vision Optometrist
000687
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000004727
—
GA
01
—
581444484
FEDERAL ID
GA
01
—
GA000687
STATE LICENSE
GA
Enumeration date
02/08/2007
Last updated
03/07/2023
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