NPI | 1013649623 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: CA 35140) |
Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: CA 35140) |
152WL0500X Optometrist Low Vision Rehabilitation (Licence: CA 35140) | |
152WP0200X Optometrist Pediatrics (Licence: CA 35140) | |
152WS0006X Optometrist Sports Vision (Licence: CA 35140) | |
152WV0400X Optometrist Vision Therapy (Licence: CA 35140) | |
152WX0102X Optometrist Occupational Vision (Licence: CA 35140) | |
Enumeration Date | 2022-06-30 |
Last Update Date | 2024-02-22 |