NPI | 1518945179 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: FL 3456) |
Additional Taxonomies | 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: FL OPC3456) |
152WC0802X Optometrist, Corneal and Contact Management (Licence: FL OPC3456) | |
Enumeration Date | 2006-01-04 |
Last Update Date | 2019-08-09 |