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General NPI Number Information
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NPI Number | 1184626459
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Entity Type | Organization
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Legal Business Name | LOUISVILLE OPTIQUE PLLC
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Dates
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Enumeration Date | 06/01/2005
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Last Update Date | 10/15/2007
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Provider Practice Location Address
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Address Line | 140 W MARKET ST
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City | LOUISVILLE
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State | KY
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Zip | 40202-1332
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Country | US
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Telephone | 502-587-8696
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Fax | 502-587-8165
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Provider Business Mailing Address
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Address Line | 140 W MARKET ST
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City | LOUISVILLE
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State | KY
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Zip | 40202-1332
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Country | US
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Telephone | 502-587-8696
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Fax | 502-587-8165
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEPHEN DAMON SMITH
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Credential | OD
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Telephone | 502-587-8696
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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 |
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License Number State |
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