Individual
WYATT LOGAN SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
580 N MERIDIAN RD, KALISPELL, MT 59901-3532
(406) 755-5910
Mailing address
580 N MERIDIAN RD, KALISPELL, MT 59901-3532
(406) 755-5910
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
5226
MT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/29/2024
Last updated
08/12/2024
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