MEDICARE: KOURTNEY EATON 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	5228	MT

General Provider Information

NPI Number	:	1205680550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KOURTNEY EATON SMITH O.D.

Provider Business Mailing Address
First Line	:	580 N MERIDIAN RD
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-3532
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	580 N MERIDIAN RD
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-3532
Country	:	US
Telephone Number	:	406-755-5910
Fax Number	:

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

Provider Enumeration Date	:	04/15/2024
Last Update Date	:	05/28/2026

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