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Individual

JONATHAN SMITH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
OD

Contact information

Practice address
780 NORTHWOOD BLVD, INCLINE VILLAGE, NV 89451-8209
(775) 831-4131
(775) 831-4165
Mailing address
780 NORTHWOOD BLVD, INCLINE VILLAGE, NV 89451-8209
(775) 831-4131
(775) 831-4165

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
267
NV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0177380002
SUPPLIER NUMBER
NV
01
1689888992
NPPES TYPE II ORGANIZATION/GROUP NPI
NV
Enumeration date
02/01/2007
Last updated
01/06/2009
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