Provider Demographics
NPI:1144282476
Name:SMITH, KYLE ALEXANDER (OD)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:ALEXANDER
Last Name:SMITH
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 1:3401 MINNESOTA DR STE 200
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-3684
Mailing Address - Country:US
Mailing Address - Phone:907-272-9800
Mailing Address - Fax:
Practice Address - Street 1:3401 MINNESOTA DR STE 200
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3684
Practice Address - Country:US
Practice Address - Phone:907-272-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK359152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist