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General NPI Number Information
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NPI Number | 1912029646
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Entity Type | Individual
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Provider Name | SUZANNE KATHLEEN SMITH O.D.
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Gender | Female
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4485 MEADOWOOD DR
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City | MULBERRY
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State | FL
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Zip | 33860-6636
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Country | US
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Telephone | 863-647-4543
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1155
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City | MULBERRY
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State | FL
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Zip | 33860-1155
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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 |
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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 | OPC002392
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2898
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License Number State | MN
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