| |
3302 Ne Stallings Dr, Nacogdoches, TX 75965-8727 | |
(936) 564-3600 | |
(936) 564-3770 |
Full Name | |
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Type | Facility |
Speciality | Ophthalmology |
Location | 3302 Ne Stallings Dr, Nacogdoches, Texas |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1750550224 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | (* (Not Available)) | Secondary |
207W00000X | Ophthalmology | (* (Not Available)) | Primary |
Provider Name | Shannon L Smith |
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Provider Type | Practitioner - Ophthalmology |
Provider Identifiers | NPI Number: 1598876237 PECOS PAC ID: 4486733557 Enrollment ID: I20080501000240 |
Mailing Address | Practice Location Address |
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3302 Ne Stallings Dr, Nacogdoches, TX 75965-8727 Ph: (936) 564-3600 | 3302 Ne Stallings Dr, Nacogdoches, TX 75965-8727 Ph: (936) 564-3600 |