Smith, Kevin L.
Smith, Kevin L. is an sole proprietor health care provider with primary practice located at 4117 Henderson Blvd , Tampa FL 33629. He recently has 3 registered licenses in different health care specialties including Eye and Vision Services Providers / Optometrist, Suppliers / Eyewear Supplier (Equipment, not the service), Eye and Vision Services Providers / Corneal and Contact Management. Eye and Vision Services Providers / Optometrist is his primary health care specialty. Smith, Kevin L. can be contacted via phone (813) 207-8984.Contact Information
Primary practice address
4117 Henderson Blvd
Tampa FL 33629
Phone: (813) 207-8984
Fax: (813) 207-8954
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 3456 | Florida |
| Suppliers / Eyewear Supplier (Equipment, not the service) | 332H00000X | OPC3456 | Florida |
| Eye and Vision Services Providers / Corneal and Contact Management | 152WC0802X | OPC3456 | Florida |
Profile Details
| NPI number | 1518945179 |
|---|---|
| LBN Legal business name | Smith, Kevin L. |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jan 4th, 2006 |
| Last updated | Aug 9th, 2019 - about 5 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 | 1518945179 | NPPES |
| Florida | Other | 11221087 | CAQH |
| Florida | Other | 582528891 | CAQH |
| Florida | Other | AJ611 | CAQH |
| Florida | MEDICAID | 620814201 | CAQH |
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