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General NPI Number Information
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NPI Number | 1700271418
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Entity Type | Organization
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Legal Business Name | DR. JILL T. SMITTLE, OPTOMETRY, INC.
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Dates
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Enumeration Date | 03/31/2015
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Last Update Date | 03/31/2015
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Provider Practice Location Address
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Address Line | 1661 GOLDEN RAIN RD
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City | SEAL BEACH
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State | CA
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Zip | 90740-4907
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Country | US
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Telephone | 562-795-6227
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7143
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City | LONG BEACH
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State | CA
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Zip | 90807-0143
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JILL SMITTLE
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Credential |
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Telephone | 562-426-1077
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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 | 9404
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License Number State | CA
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