Angela Smith, LDO
Individual provider Active NPI Optician · Mulberry, FL
NPI 1134819543 · NPPES record last updated May 9, 2023
Key facts
- NPI
- 1134819543
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optician 156FX1800X
- License
- DO3518 (FL)
- Practice address
- 6745 N Church Ave
Mulberry, FL 33860-2080 - Phone
- (863) 701-2573
- Fax
- (863) 701-2595
- NPI assigned
- May 9, 2023
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DO3518 | FL | MD | Optician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician | 156FX1800X | DO3518 | FL | Yes |
Addresses
Primary practice location
6745 N Church Ave
Mulberry, FL 33860-2080
Mailing address
6810 Glenbrook Dr
Lakeland, FL 33811-2390
Phone (863) 797-5066
Other providers in Mulberry, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 9, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.