Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156F00000X | Technician/Technologist | ||
N | 156FC0800X | Contact Lens | ||
N | 156FX1100X | Ophthalmic | ||
N | 156FX1101X | Ophthalmic Assistant | ||
N | 156FX1201X | Optometric Assistant | ||
N | 156FX1202X | Optometric Technician | ||
Y | 156FX1800X | Optician |
NPI | 1326477316 |
---|---|
Provider Name | Krista Valarie Smit |
First Address | Sioux Falls, SD 57108-2865 |
Second Address | Sioux Falls, SD 57108-2865 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2013 |
Last Update Date | 11/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1026-7978-ST | SD DEPT. OF REVENUE (01) | SD |