Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | DO3441 | FL |
NPI | 1003051194 |
---|---|
Provider Name | Alane Renee Clarke |
First Address | Sarasota, FL 34243-2903 |
Second Address | Sarasota, FL 34243-2903 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2008 |
Last Update Date | 04/12/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
630372200 | (05) | FL |