MEDICARE: VIVIEN M SMITH OD PSC

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	1223DT	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164536876
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIVIEN M SMITH OD PSC

Provider Business Mailing Address
First Line	:	3735 PALOMAR CENTER DRIVE
Second Line	:	SUITE 45
City	:	LEXINGTON
State	:	KY
Zip	:	40513-1147
Country	:	US
Telephone Number	:	859-224-8083
Fax Number	:	859-223-2913

Provider Business Practice Location Address
First Line	:	3735 PALOMAR CENTER DRIVE
Second Line	:	SUITE 45
City	:	LEXINGTON
State	:	KY
Zip	:	40513-1147
Country	:	US
Telephone Number	:	859-224-8083
Fax Number	:	859-223-2913

Authorized Official
Title or Position	:	OWNER OPTOMETRIST
Name	:	DR. VIVIEN MARY SMITH
Credential	:	OD
Telephone Number	:	859-224-8083

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	12/03/2007

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