Basic Information
Provider Information
NPI: 1003011636
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SMERIGLIO
FirstName: JAMES
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: O.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3108 MULLINEAUX LN
Address2:  
City: ELLICOTT CITY
State: MD
PostalCode: 210427104
CountryCode: US
TelephoneNumber: 4107500721
FaxNumber:  
Practice Location
Address1: 11200 ROCKVILLE PIKE
Address2: SUITE 210
City: ROCKVILLE
State: MD
PostalCode: 208523154
CountryCode: US
TelephoneNumber: 3016549777
FaxNumber: 3016549794
Other Information
ProviderEnumerationDate: 06/14/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
152W00000XTA1092MDY Eye and Vision Services ProvidersOptometrist 

No ID Information.


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