Individual
DR. STEPHEN DAMON SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
140 W MARKET ST, LOUISVILLE, KY 40202-1332
(502) 587-8696
(502) 587-8165
Mailing address
140 W MARKET ST, LOUISVILLE, KY 40202-1332
(502) 587-8696
(502) 587-8165
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1445 DT
KY
152W00000X
Optometrist
18002709
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000198612
ANTHEM PROVIDER
KY
01
—
11221323
CAQH
KY
01
—
1445DT
KY OPTOMETRY LICENSE
KY
01
—
18002709
IN OPTOMETRY LICENSE
IN
01
—
21434
CVC PROVIDER
KY
05
—
77340503
—
KY
01
—
918468
BLOCK PROVIDER
KY
Enumeration date
06/01/2005
Last updated
03/07/2023
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