Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FC0801X | Contact Lens Fitter | ||
Y | 156FX1800X | Optician |
NPI | 1003351743 |
---|---|
Provider Name | Alfred Namrood |
First Address | Chicago, IL 60659-1502 |
Second Address | Chicago, IL 60659-1502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2017 |
Last Update Date | 04/01/2017 |