Individual
MARY LOU SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
148 13TH ST SW, LARGO, FL 33770-3127
(727) 581-8706
(727) 586-3743
Mailing address
PO BOX 2410, LARGO, FL 33779-2410
(727) 581-8706
(727) 586-3743
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC2593
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
078988700
—
FL
Enumeration date
07/08/2005
Last updated
10/14/2019
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