Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OEG001852 | PA |
NPI | 1003038316 |
---|---|
Provider Name | Brook T Kressley |
First Address | Moon Twp, PA 15108-4709 |
Second Address | Sewickley, PA 15143-1500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OEG001852 | STATE LICENSE (01) | PA |