=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437256955
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAREN SMITH VANOY O.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2006
-----------------------------------------------------
Last Update Date | 03/08/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 130 WILDWOOD PKWY
-----------------------------------------------------
City | HOMEWOOD
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35209-7187
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-942-0377
-----------------------------------------------------
Fax | 205-945-6775
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15933 CLAYTON RD SUITE 201
-----------------------------------------------------
City | BALLWIN
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63011-2172
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-200-4393
-----------------------------------------------------
Fax | 636-527-0766
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | S865TA419
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------