Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1134756307 |
---|---|
Provider Name | Barry William Brobst |
First Address | Bethlehem, PA 18018-6506 |
Second Address | Bethlehem, PA 18018-6506 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2020 |
Last Update Date | 26/03/2020 |