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Individual

MRS. TAMARA SMITH OLD

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
O.D.

Contact information

Practice address
4874 SPARKS BLVD, SPARKS, NV 89436-8206
(775) 358-1317
(775) 355-7522
Mailing address
4874 SPARKS BLVD, SPARKS, NV 89436-8206
(775) 358-1317
(775) 355-7522

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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