Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1063922722 |
---|---|
Provider Name | Brian Pitko |
First Address | Clinton Township, MI 48038-3643 |
Second Address | Clinton Township, MI 48038-3643 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2017 |
Last Update Date | 16/06/2018 |