Provider Demographics
NPI:1811492507
Name:BALLARD, ERICA SMITH (OD)
Entity type:Individual
Prefix:DR
First Name:ERICA
Middle Name:SMITH
Last Name:BALLARD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:ASHLEY
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:740 S LIMESTONE ROOM C301
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-8114
Mailing Address - Country:US
Mailing Address - Phone:859-323-5867
Mailing Address - Fax:859-323-1122
Practice Address - Street 1:110 CONN TER STE 550
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-3206
Practice Address - Country:US
Practice Address - Phone:859-323-5867
Practice Address - Fax:859-323-8510
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2114DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist