| NPI | 1003822834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618002214) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 5064TG) |
| 152W00000X Optometrist (Licence: FL TPOP45) | |
| 152W00000X Optometrist (Licence: MD TA1207) | |
| 152W00000X Optometrist (Licence: PA OEG003773) | |
| 152W00000X Optometrist (Licence: WI 21290-875) | |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: TX 5064TG) | |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: TX 5064TG) | |
| 152WP0200X Optometrist, Pediatrics (Licence: TX 5064TG) | |
| 152WS0006X Optometrist, Sports Vision (Licence: TX 5064TG) | |
| 152WV0400X Optometrist, Vision Therapy (Licence: TX 5064TG) | |
| 152WX0102X Optometrist, Occupational Vision (Licence: TX 5064TG) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2022-02-22 |