Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 004744-1 | NY |
NPI | 1093935561 |
---|---|
Provider Name | Anthony Francis Cornell |
First Address | Ravena, NY 12143 |
Second Address | Ravena, NY 12143 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2007 |
Last Update Date | 23/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T26670 | (02) |