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NPI Code Detail

MEDICARE: MARY LOU SMITH OD

MEDICARE: MARY LOU SMITH OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometristOPC2593FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558369108
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY LOU SMITH OD
Provider Business Mailing Address
First Line : PO BOX 2410
Second Line :
City : LARGO
State : FL
Zip : 33779-2410
Country : US
Telephone Number : 727-581-8706
Fax Number : 727-586-3743
Provider Business Practice Location Address
First Line : 148 13TH ST SW
Second Line :
City : LARGO
State : FL
Zip : 33770-3127
Country : US
Telephone Number : 727-581-8706
Fax Number : 727-586-3743
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2005
Last Update Date : 10/14/2019

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