MEDICARE: KYLE ALEXANDER SMITH O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	359	AK

General Provider Information

NPI Number	:	1144282476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE ALEXANDER SMITH O.D.

Provider Business Mailing Address
First Line	:	3401 MINNESOTA DR STE 200
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99503-3684
Country	:	US
Telephone Number	:	907-272-9800
Fax Number	:

Provider Business Practice Location Address
First Line	:	3401 MINNESOTA DR STE 200
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99503-3684
Country	:	US
Telephone Number	:	907-272-9800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	12/04/2019

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