Individual
SAMUEL SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COA
Contact information
Practice address
1501 SAN PEDRO DR SE, ALBUQUERQUE, NM 87108-5153
(505) 265-1711
Mailing address
13 BACUS AVE APT 9, DURANGO, CO 81301-4161
(971) 258-4097
Taxonomy
Speciality
Code
Description
License number
State
156FX1100X
Ophthalmic Technician/Technologist
Primary
COA
—
Other
Enumeration date
07/25/2021
Last updated
07/25/2021
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