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NPI Code Detail

MEDICARE: MRS. KELLY SMITH

MEDICARE: MRS. KELLY SMITH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1156FX1800XOpticianDO 5210FL

General Provider Information

NPI Number : 1932199700
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KELLY SMITH
Provider Business Mailing Address
First Line : 9201 CYPRESS LAKE DR
Second Line :
City : FORT MYERS
State : FL
Zip : 33919-4941
Country : US
Telephone Number : 239-481-3343
Fax Number : 239-482-5227
Provider Business Practice Location Address
First Line : 9201 CYPRESS LAKE DR
Second Line :
City : FORT MYERS
State : FL
Zip : 33919-4941
Country : US
Telephone Number : 239-481-3343
Fax Number : 239-482-5227
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2005
Last Update Date : 03/11/2008

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Directions to “ MRS. KELLY SMITH ” Practice Location

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