Smith, Kelly A
Smith, Kelly A is an individual health care provider with primary practice located at 607 Boll Weevil Cir Ste C , Enterprise AL 36330-2733. She recently has 3 registered licenses in different health care specialties including Eye and Vision Services Providers / Optometrist, Eye and Vision Services Providers / Corneal and Contact Management, Eye and Vision Services Providers / Pediatrics. Eye and Vision Services Providers / Optometrist is her primary health care specialty. Smith, Kelly A can be contacted via phone (334) 347-6599.Contact Information
Primary practice address
607 Boll Weevil Cir Ste C
Enterprise AL 36330-2733
Phone: (334) 347-6599
Fax: (334) 417-0190
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | OPC 4065 | Florida |
| Eye and Vision Services Providers / Corneal and Contact Management | 152WC0802X | OPC 4065 | Florida |
| Eye and Vision Services Providers / Corneal and Contact Management | 152WC0802X | S-B14-TA-705 | Alabama |
| Eye and Vision Services Providers / Pediatrics | 152WP0200X | OPC 4065 | Florida |
| Eye and Vision Services Providers / Pediatrics | 152WP0200X | S-B14-TA-705 | Alabama |
| Eye and Vision Services Providers / Optometrist | 152W00000X | S-B14-TA-705 | Alabama |
Profile Details
| NPI number | 1881619955 |
|---|---|
| LBN Legal business name | Smith, Kelly A |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 12th, 2006 |
| Last updated | Aug 31st, 2022 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1881619955 | NPPES |
| Florida | MEDICAID | 621068600 | |
| Florida | MEDICAID | 240878 | |
| Florida | Other | P0030826 | |
| Florida | Other | 28556 |
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