MEDICARE: KENNETH C. 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	TUV005868-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1561736	OTHER	NY	CIGNA
3	6599281	OTHER	NY	GHI
4	18216P	OTHER	NY	HIP
5	3750977	OTHER	NY	AETNA HMO
6	6C0858	OTHER	NY	HEALTHNET
7	7652507	OTHER	NY	AETNA PPO/EPO
8	C367E1	OTHER	NY	EMPIRE BLUE CROSS BLUE SH
9	P2929150	OTHER	NY	OXFORD HEALTH PLAN

General Provider Information

NPI Number	:	1568436095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH C. SMITH O.D.

Provider Business Mailing Address
First Line	:	401 E 34TH ST
Second Line	:	SOUTH 3B
City	:	NEW YORK
State	:	NY
Zip	:	10016-4914
Country	:	US
Telephone Number	:	212-679-0766
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 E 34TH ST
Second Line	:	SOUTH 3B
City	:	NEW YORK
State	:	NY
Zip	:	10016-4914
Country	:	US
Telephone Number	:	212-679-0766
Fax Number	:	212-532-3213

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

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	06/26/2025

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Directions to “ KENNETH C. SMITH O.D.” Practice Location

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