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General NPI Number Information
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NPI Number | 1487844536
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Entity Type | Organization
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Legal Business Name | KEVIN SMITH OD AND ASSOCIATES INC
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Dates
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Enumeration Date | 07/25/2007
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Last Update Date | 11/04/2008
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Provider Practice Location Address
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Address Line | 4117 HENDERSON BLVD
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City | TAMPA
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State | FL
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Zip | 33629-5749
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Country | US
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Telephone | 813-207-8984
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Fax | 813-207-8954
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Provider Business Mailing Address
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Address Line | 4117 HENDERSON BLVD
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City | TAMPA
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State | FL
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Zip | 33629-5749
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Country | US
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Telephone | 813-207-8984
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Fax | 813-207-8954
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. KEVIN L SMITH
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Credential | OD
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Telephone | 813-312-1174
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | OPC 3456
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | OPC3456
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License Number State | FL
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