Individual
JENNIFER MAUNEY SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2052
NC
152WP0200X
Pediatric Optometrist
2052
NC
152WV0400X
Vision Therapy Optometrist
2052
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
145FK
BCBS
NC
01
—
2388088
WELLCARE
—
05
—
5907709
—
NC
Enumeration date
04/04/2007
Last updated
12/30/2022
Update your record
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