Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FC0801X | Contact Lens Fitter | SC.7149 | OH |
N | 156FX1800X | Optician | SC.7149 | OH |
NPI | 1457749673 |
---|---|
Provider Name | Shalina Smith |
First Address | Medina, OH 44258-1873 |
Second Address | Cleveland, OH 44102-4753 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/12/2014 |
Last Update Date | 07/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0082317 | (05) | OH |