MEDICARE: DR. KEVIN L. 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	152WC0802X	Corneal and Contact Management Optometrist	OPC3456	FL
2	332H00000X	Eyewear Supplier	OPC3456	FL
3	152W00000X	Optometrist	3456	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	AJ611	OTHER	FL	GROUP MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11221087	OTHER	FL	CAQH
2	582528891	OTHER	FL	IRS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518945179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN L. SMITH O.D.

Provider Business Mailing Address
First Line	:	13621 N FLORIDA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33613-3216
Country	:	US
Telephone Number	:	813-207-8984
Fax Number	:	813-207-8954

Provider Business Practice Location Address
First Line	:	13621 N FLORIDA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33613-3216
Country	:	US
Telephone Number	:	813-803-4515
Fax Number	:	813-803-4513

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

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	03/19/2026

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