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General NPI Number Information
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NPI Number | 1164536876
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Entity Type | Organization
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Legal Business Name | VIVIEN M SMITH OD PSC
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 12/03/2007
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Provider Practice Location Address
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Address Line | 3735 PALOMAR CENTER DRIVE SUITE 45
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City | LEXINGTON
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State | KY
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Zip | 40513-1147
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Country | US
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Telephone | 859-224-8083
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Fax | 859-223-2913
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Provider Business Mailing Address
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Address Line | 3735 PALOMAR CENTER DRIVE SUITE 45
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City | LEXINGTON
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State | KY
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Zip | 40513-1147
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Country | US
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Telephone | 859-224-8083
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Fax | 859-223-2913
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Authorized Official
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Title or Position | OWNER OPTOMETRIST
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Name | DR. VIVIEN MARY SMITH
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Credential | OD
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Telephone | 859-224-8083
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1223DT
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License Number State | KY
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