Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 1544 | SC |
NPI | 1003056656 |
---|---|
Provider Name | Bettina L Gary |
First Address | Columbia, SC 29209-2627 |
Second Address | Columbia, SC 29209-2627 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2009 |
Last Update Date | 06/10/2009 |