Kenneth George Smith, MD
Individual provider Active NPI Ophthalmology Physician · High Rolls, NM
NPI 1962067439 · NPPES record last updated May 9, 2019
Key facts
- NPI
- 1962067439
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Ophthalmology Physician 207W00000X
- License
- 73-70 (NM)
- Practice address
- 26 Apple Valley Road
High Rolls, NM 88325 - Phone
- (575) 632-1134
- NPI assigned
- May 9, 2019
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 73-70 | NM | MD | Ophthalmology Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 73-70 | NM | Yes |
Addresses
Primary practice location
26 Apple Valley Road
High Rolls, NM 88325
Mailing address
PO Box 442
High Rolls Mountain Park, NM 88325-0442
Phone (575) 682-1134
Other providers in High Rolls, NM
All providers in High Rolls, NM · Ophthalmology Physician in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 9, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.