Provider Demographics
NPI:1568654614
Name:SMRKOVSKI, TINA MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:MARIE
Last Name:SMRKOVSKI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:MARIE
Other - Last Name:GLOWACKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:63 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:NH
Mailing Address - Zip Code:03743-2605
Mailing Address - Country:US
Mailing Address - Phone:603-543-3125
Mailing Address - Fax:
Practice Address - Street 1:63 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:NH
Practice Address - Zip Code:03743-2605
Practice Address - Country:US
Practice Address - Phone:603-543-3125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0808152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30356092Medicaid
NH30356092Medicaid