Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | TA2087 | MD |
NPI | 1003083486 |
---|---|
Provider Name | Cerella F Rainey |
First Address | Vienna, VA 22182-3970 |
Second Address | Frederick, MD 21703-9441 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2008 |
Last Update Date | 26/05/2020 |