=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912049511
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KIMBERLY ZIMMER SMITH O.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2007
-----------------------------------------------------
Last Update Date | 03/23/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1560 HUSTONVILLE RD STE 205
-----------------------------------------------------
City | DANVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40422-2460
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-236-8644
-----------------------------------------------------
Fax | 859-239-9561
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 104 SMOKY WAY STE 100
-----------------------------------------------------
City | DANVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40422-8729
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-236-8644
-----------------------------------------------------
Fax | 859-239-9561
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 1586DT
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------