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Individual

DR. GARY THOMAS SMITH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
79 MALL ROAD, SUITE A, SOUTH WILLIAMSON, KY 41503-4079
(606) 237-4551
(606) 237-4592
Mailing address
79 MALL ROAD, SOUTHSIDE PROFESSIONAL BLDG, SUITE A, SOUTH WILLIAMSON, KY 41503-4079
(606) 237-4551
(606) 237-4592

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
KY1198DT
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0150046000
WV
05
77011989
KY
Enumeration date
10/20/2006
Last updated
09/26/2012
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