Individual
MRS. JILL MARIE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
4181 BROADWAY ST, KANSAS CITY, MO 64111-2620
(816) 756-3577
(816) 756-3069
Mailing address
4181 BROADWAY ST, KANSAS CITY, MO 64111-2620
(816) 756-3577
(816) 756-3069
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
1468
KS
152W00000X
Optometrist
Primary
T03249
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100220990D
—
KS
05
—
318585205
—
MO
Enumeration date
02/03/2006
Last updated
03/31/2011
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