Individual
KATHRYN JEANNINE SMOLTINO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
115 E CHURCH ST, LEESVILLE, SC 29070-7595
(803) 532-5339
Mailing address
115 E CHURCH ST, LEESVILLE, SC 29070-7595
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
1063
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1063
SC OPTICIANS LICENSE
—
Enumeration date
07/25/2022
Last updated
04/19/2023
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