Provider Demographics
NPI:1205199247
Name:UMBEL, TONYA MARIE SMITH (OD)
Entity Type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:MARIE SMITH
Last Name:UMBEL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:536 EMILY DR STE B
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-5507
Mailing Address - Country:US
Mailing Address - Phone:304-566-7709
Mailing Address - Fax:304-715-2070
Practice Address - Street 1:536 EMILY DR STE B
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-5507
Practice Address - Country:US
Practice Address - Phone:304-566-7709
Practice Address - Fax:304-715-2070
Is Sole Proprietor?:No
Enumeration Date:2012-06-22
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2000-IOD152W00000X, 152W00000X
VA0618002293152WL0500X, 152WP0200X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2000-IOD1OtherSTATE OPTOMETRY LICENCE