NPI | 1144260969 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: ID ODP-100014) |
Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: ID ODP-100014) |
152WL0500X Optometrist, Low Vision Rehabilitation (Licence: ID ODP-100014) | |
152WP0200X Optometrist, Pediatrics (Licence: ID ODP-100014) | |
152WS0006X Optometrist, Sports Vision (Licence: ID ODP-100014) | |
152WV0400X Optometrist, Vision Therapy (Licence: ID ODP-100014) | |
152WX0102X Optometrist, Occupational Vision (Licence: ID ODP-100014) | |
Enumeration Date | 2006-06-08 |
Last Update Date | 2010-07-22 |