Healthcare Provider Details

I. General information

NPI: 1013251636
Provider Name (Legal Business Name): KIMBERLY SMITH, OD & ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2012
Last Update Date: 11/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 CUNNINGHAM DRIVE
CINCINNATI OH
45241
US

IV. Provider business mailing address

2801 CUNNINGHAM DRIVE
CINCINNATI OH
45241
US

V. Phone/Fax

Practice location:
  • Phone: 513-769-1184
  • Fax: 513-769-1264
Mailing address:
  • Phone: 513-769-1184
  • Fax: 513-769-1264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4594
License Number StateOH

VIII. Authorized Official

Name: DR. KIMBERLY DENISE SMITH
Title or Position: OPTOMETRIST
Credential: OD
Phone: 513-379-4482