Individual
MRS. TAMARA SMITH OLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
415
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
V100563
MEDICARE ID-PIN
NV
Enumeration date
10/17/2006
Last updated
10/05/2023
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