| NPI | 1578687364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: NY NY3728) |
| Additional Taxonomies | 156FC0800X Technician/Technologist, Contact Lens (Licence: NY NY3728) |
| 156FC0801X Technician/Technologist, Contact Lens Fitter (Licence: NY NY3728) | |
| 156FX1800X Technician/Technologist, Optician (Licence: NY NY3728) | |
| Enumeration Date | 2007-03-18 |
| Last Update Date | 2014-05-10 |