1437337144 NPI number — DR. GARY T SMITH FAMILY EYE CARE INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437337144 NPI number — DR. GARY T SMITH FAMILY EYE CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. GARY T SMITH FAMILY EYE CARE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437337144
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
79 MALL ROAD
Provider Second Line Business Mailing Address:
SOUTHSIDE PROFESSIONAL BLDG, SUITE A
Provider Business Mailing Address City Name:
SOUTH WILLIAMSON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-237-4551
Provider Business Mailing Address Fax Number:
606-237-4592

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
79 MALL ROAD
Provider Second Line Business Practice Location Address:
SOUTHSIDE PROFESSIONAL BLDG, SUITE A
Provider Business Practice Location Address City Name:
SOUTH WILLIAMSON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-237-4551
Provider Business Practice Location Address Fax Number:
606-237-4592
Provider Enumeration Date:
02/05/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
GARY
Authorized Official Middle Name:
THOMAS
Authorized Official Title or Position:
OPTOMETRIST
Authorized Official Telephone Number:
606-237-4551

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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