Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 007454 | NY |
NPI | 1063636207 |
---|---|
Provider Name | Carey L Doane |
First Address | Ithaca, NY 14850-1865 |
Second Address | Ithaca, NY 14850-1865 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
007454 | LICENSE (01) | NY |