Individual
KEVAN SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1245 MADISON AVE, MEMPHIS, TN 38104-2211
(901) 722-3200
Mailing address
6989 ISLAND RD, CICERO, NY 13039-9761
(315) 436-7613
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3551
TN
Other
Enumeration date
05/22/2019
Last updated
10/30/2019
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