Provider Demographics
NPI:1437337144
Name:DR. GARY T SMITH FAMILY EYE CARE INC
Entity Type:Organization
Organization Name:DR. GARY T SMITH FAMILY EYE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:606-237-4551
Mailing Address - Street 1:79 MALL ROAD
Mailing Address - Street 2:SOUTHSIDE PROFESSIONAL BLDG, SUITE A
Mailing Address - City:SOUTH WILLIAMSON
Mailing Address - State:KY
Mailing Address - Zip Code:41503
Mailing Address - Country:US
Mailing Address - Phone:606-237-4551
Mailing Address - Fax:606-237-4592
Practice Address - Street 1:79 MALL ROAD
Practice Address - Street 2:SOUTHSIDE PROFESSIONAL BLDG, SUITE A
Practice Address - City:SOUTH WILLIAMSON
Practice Address - State:KY
Practice Address - Zip Code:41503
Practice Address - Country:US
Practice Address - Phone:606-237-4551
Practice Address - Fax:606-237-4592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1236050001Medicare NSC