Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 2059 | AZ |
NPI | 1003299538 |
---|---|
Provider Name | Adam Mcdonald |
First Address | Tucson, AZ 85705-5093 |
Second Address | Tucson, AZ 85705-5093 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2015 |
Last Update Date | 08/07/2020 |