MEDICARE: MS. KATHRYN ELIZABETH SMITH O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	7306TG	TX

General Provider Information

NPI Number	:	1013165547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHRYN ELIZABETH SMITH O.D.

Provider Business Mailing Address
First Line	:	1801 E 51ST ST STE 360
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78723-3468
Country	:	US
Telephone Number	:	512-271-6677
Fax Number	:	512-271-6674

Provider Business Practice Location Address
First Line	:	1801 E 51ST ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78723-3434
Country	:	US
Telephone Number	:	512-271-6677
Fax Number	:	512-271-6674

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2008
Last Update Date	:	08/26/2022

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