Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 10095 | TX |
NPI | 1013531060 |
---|---|
Provider Name | Lisa Marie Smith |
First Address | Collinsville, TX 76233 |
Second Address | Collinsville, TX 76233 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2020 |
Last Update Date | 30/11/2020 |