Provider Demographics
NPI:1053472407
Name:SMITTLE, JILL TERRY (OD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:TERRY
Last Name:SMITTLE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:3836 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3404
Mailing Address - Country:US
Mailing Address - Phone:310-937-6585
Mailing Address - Fax:310-542-3809
Practice Address - Street 1:1661 GOLDEN RAIN RD
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-4907
Practice Address - Country:US
Practice Address - Phone:562-795-6227
Practice Address - Fax:562-430-6351
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9404T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist