Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 1002 | SC |
NPI | 1093323289 |
---|---|
Provider Name | Benjamin Cade |
First Address | Liberty, SC 29657-9300 |
Second Address | Pickens, SC 29671-2479 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2020 |
Last Update Date | 14/07/2020 |