Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 2428 | MA |
NPI | 1013090893 |
---|---|
Provider Name | C. Roger Armstrong |
First Address | Danvers, MA 01923 |
Second Address | Danvers, MA 01923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0351393 | (05) | MS |
T95523 | (02) | MA |