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General NPI Number Information
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NPI Number | 1184828576
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Entity Type | Organization
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Legal Business Name | SCOTT SMITH, OD PLLC
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Dates
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Enumeration Date | 06/12/2007
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Last Update Date | 09/12/2012
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Provider Practice Location Address
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Address Line | 500 W BROADWAY ST
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City | LAWRENCEBURG
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State | KY
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Zip | 40342-1306
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Country | US
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Telephone | 502-839-5113
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Fax | 502-839-9831
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Provider Business Mailing Address
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Address Line | PO BOX 168
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City | LAWRENCEBURG
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State | KY
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Zip | 40342-0168
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Country | US
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Telephone | 502-839-5113
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Fax | 502-839-9831
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Authorized Official
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Title or Position | MEMBER
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Name | SCOTT SMITH
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Credential | O.D.
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Telephone | 502-839-5113
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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 | 1390DT
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License Number State | KY
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