Provider Demographics
NPI:1154463255
Name:SMITH, JEREMY VANLORING (OD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:VANLORING
Last Name:SMITH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 W PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:CYNTHIANA
Mailing Address - State:KY
Mailing Address - Zip Code:41031-1434
Mailing Address - Country:US
Mailing Address - Phone:859-234-1424
Mailing Address - Fax:
Practice Address - Street 1:202 W PLEASANT ST
Practice Address - Street 2:
Practice Address - City:CYNTHIANA
Practice Address - State:KY
Practice Address - Zip Code:41031-1434
Practice Address - Country:US
Practice Address - Phone:859-234-1424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1626DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYV02639Medicare UPIN