Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 8177T | CA |
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 8177T | CA |
NPI | 1306975982 |
---|---|
Provider Name | B G Shily |
First Address | Beverly Hills, CA 90212-3415 |
Second Address | Beverly Hills, CA 90212-3419 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2007 |
Last Update Date | 30/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U26404 | (02) | CA |