Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 270A00522700 | NJ |
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 27OA00522700 | NJ |
NPI | 1093999237 |
---|---|
Provider Name | Dr. Lisa Valerie Gaines-Smith |
First Address | Totowa, NJ 07512-2338 |
Second Address | Totowa, NJ 07512-2338 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/12/2007 |
Last Update Date | 16/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
148709 | (02) | NJ |