Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1700X | Ocularist | 89-227-07 | CA |
NPI | 1346314416 |
---|---|
Provider Name | Carole Lewis Stolpe |
First Address | Beverly Hills, CA 90210-4321 |
Second Address | Beverly Hills, CA 90210-4321 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2006 |
Last Update Date | 17/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DX0899010 | (05) | CA |