Provider Demographics
NPI:1407968969
Name:SMITHSON, KERRY (OD)
Entity Type:Individual
Prefix:DR
First Name:KERRY
Middle Name:
Last Name:SMITHSON
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 1:902 BULLION ST
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-5402
Mailing Address - Country:US
Mailing Address - Phone:801-261-3228
Mailing Address - Fax:801-264-7942
Practice Address - Street 1:5469 S REDWOOD RD
Practice Address - Street 2:WAL-MART VISION CENTER
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84123-5318
Practice Address - Country:US
Practice Address - Phone:801-261-1271
Practice Address - Fax:801-264-7942
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT109834-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist