Provider Demographics
NPI:1619019213
Name:DANVILLE EYE CENTER, PLLC
Entity type:Organization
Organization Name:DANVILLE EYE CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ZIMMER
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:859-236-8644
Mailing Address - Street 1:104 SMOKY WAY
Mailing Address - Street 2:STE. 100
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-2460
Mailing Address - Country:US
Mailing Address - Phone:859-236-8644
Mailing Address - Fax:859-236-0523
Practice Address - Street 1:104 SMOKY WAY,
Practice Address - Street 2:STE. 100
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-2460
Practice Address - Country:US
Practice Address - Phone:859-236-8644
Practice Address - Fax:859-236-0523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77904043Medicaid
KY9318Medicare ID - Type Unspecified