Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 008838 | NY |
N | 152W00000X | Optometrist | ODGT00711 | RI |
NPI | 1003393273 |
---|---|
Provider Name | Brittany Hazelton |
First Address | Warwick, RI 02886-6100 |
Second Address | Warwick, RI 02886-6100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2018 |
Last Update Date | 18/08/2021 |