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General NPI Number Information
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NPI Number | 1689297210
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Entity Type | Individual
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Provider Name | KAYLA SMITH OD
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Gender | Female
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Dates
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Enumeration Date | 05/18/2020
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Last Update Date | 08/18/2020
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Provider Practice Location Address
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Address Line | 6836 BEE CAVES RD # 100
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City | AUSTIN
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State | TX
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Zip | 78746-5059
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Country | US
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Telephone | 512-614-1640
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Fax |
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Provider Business Mailing Address
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Address Line | 32415 5 MILE RD
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City | LIVONIA
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State | MI
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Zip | 48154-3039
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Country | US
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Telephone | 517-899-0296
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number | 9820T
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number | 9820T
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4901005478
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 9820T
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License Number State | TX
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