Provider Demographics
NPI:1740459213
Name:SCOTT SMITH OD, PLLC
Entity type:Organization
Organization Name:SCOTT SMITH OD, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:502-839-5113
Mailing Address - Street 1:PO BOX 168
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40342-0168
Mailing Address - Country:US
Mailing Address - Phone:502-839-5113
Mailing Address - Fax:502-839-9831
Practice Address - Street 1:500 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:KY
Practice Address - Zip Code:40342-1306
Practice Address - Country:US
Practice Address - Phone:502-839-5113
Practice Address - Fax:502-839-9831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1390DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY45004413Medicaid
KY77013902Medicaid
KY000000217614OtherBLUE CROSS BLUE SHIELD
KYP00204906OtherRAIL ROAD MEDICARE
KYU74201Medicare UPIN
KY45004413Medicaid