Organization
KEVIN SMITH OD AND ASSOCIATES INC
Active
Other names
SOUTH TAMPA EYE SITE
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN L. SMITH O.D. (PRESIDENT)
(813) 207-8984
Entity
Organization
Contact information
Practice address
4117 HENDERSON BLVD, TAMPA, FL 33629-5749
(813) 207-8984
Mailing address
4117 HENDERSON BLVD, TAMPA, FL 33629-5749
(813) 207-8984
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
152WC0802X
Corneal and Contact Management Optometrist
Primary
—
—
152WL0500X
Low Vision Rehabilitation Optometrist
—
—
332H00000X
Eyewear Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5929060001
PTAN
FL
05
—
620814200
—
FL
01
—
OPC3456
STATE OF FLORIDA
FL
Enumeration date
05/22/2008
Last updated
05/22/2008
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