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General NPI Number Information
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NPI Number | 1821284613
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Entity Type | Individual
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Provider Name | RACHAEL MARTHA SMITH O.D.
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Gender | Female
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Dates
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Enumeration Date | 09/14/2007
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Last Update Date | 09/14/2007
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Provider Practice Location Address
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Address Line | 7780 W ARROWHEAD TOWNE CTR
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City | GLENDALE
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State | AZ
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Zip | 85308-8612
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Country | US
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Telephone | 623-978-7628
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Fax |
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Provider Business Mailing Address
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Address Line | 6822 N 55TH DR
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City | GLENDALE
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State | AZ
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Zip | 85301-3308
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Country | US
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Telephone | 623-293-1752
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Fax |
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1286AZ
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License Number State | AZ
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