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General NPI Number Information
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NPI Number | 1134819543
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Entity Type | Individual
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Provider Name | ANGELA SMITH LDO
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Gender | Female
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Dates
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Enumeration Date | 05/09/2023
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Last Update Date | 05/09/2023
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Provider Practice Location Address
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Address Line | 6745 N CHURCH AVE
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City | MULBERRY
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State | FL
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Zip | 33860-2080
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Country | US
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Telephone | 863-701-2573
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Fax | 863-701-2595
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Provider Business Mailing Address
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Address Line | 6810 GLENBROOK DR
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City | LAKELAND
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State | FL
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Zip | 33811-2390
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Country | US
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Telephone | 863-797-5066
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Fax | 863-701-2595
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | DO3518
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License Number State | FL
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