Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 245638 | KY |
NPI | 1093303901 |
---|---|
Provider Name | Amanda Simmerman |
First Address | Lexington, KY 40508-3206 |
Second Address | Lexington, KY 40508-3206 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2021 |
Last Update Date | 07/01/2021 |