Organization
EYE PHYSICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARITA SMITH (OPTOMETRIST)
(312) 397-0403
Entity
Organization
Contact information
Practice address
835 N MICHIGAN AVE, CHICAGO, IL 60611-2203
(312) 397-0403
(312) 397-0390
Mailing address
PO BOX 6476, CHICAGO, IL 60680-6476
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
152WC0802X
Corneal and Contact Management Optometrist
—
—
152WL0500X
Low Vision Rehabilitation Optometrist
—
—
152WP0200X
Pediatric Optometrist
—
—
152WV0400X
Vision Therapy Optometrist
—
—
Other
Enumeration date
09/20/2016
Last updated
10/12/2016
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