MEDICARE: SAGE AMIRA 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
1	152W00000X	Optometrist	0618003640	VA

General Provider Information

NPI Number	:	1821922758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAGE AMIRA SMITH OD

Provider Business Mailing Address
First Line	:	8350 TRAFORD LN
Second Line	:
City	:	WEST SPRINGFIELD
State	:	VA
Zip	:	22152-1664
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8350 TRAFORD LN
Second Line	:
City	:	WEST SPRINGFIELD
State	:	VA
Zip	:	22152-1664
Country	:	US
Telephone Number	:	703-569-6363
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2026
Last Update Date	:	06/08/2026

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