Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | MA |
NPI | 1194854703 |
---|---|
Provider Name | Carlos Alberto Soares |
First Address | Fall River, MA 02723-1901 |
Second Address | Fall River, MA 02723-1901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2007 |
Last Update Date | 03/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1531085 | MASS HEALTH ID# (01) | MA |