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General NPI Number Information
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NPI Number | 1477790301
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Entity Type | Organization
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Legal Business Name | TIFFANY SMART, O.D.
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Dates
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Enumeration Date | 01/14/2009
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Last Update Date | 01/14/2009
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Provider Practice Location Address
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Address Line | 590 HARBOR ST
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City | MORRO BAY
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State | CA
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Zip | 93442-1904
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Country | US
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Telephone | 805-772-1269
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Fax | 805-772-2172
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Provider Business Mailing Address
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Address Line | 590 HARBOR ST
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City | MORRO BAY
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State | CA
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Zip | 93442-1904
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Country | US
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Telephone | 805-772-1269
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Fax | 805-772-2172
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. TIFFANY TYLER SMART
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Credential | O.D.
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Telephone | 805-772-1269
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 12647
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License Number State | CA
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