Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1225491541 |
---|---|
Provider Name | Anna Nicotera |
First Address | Greece, NY 14626-3054 |
Second Address | Greece, NY 14626-3054 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2016 |
Last Update Date | 04/04/2016 |