Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | SL561 CL4021 | CA |
NPI | 1053528521 |
---|---|
Provider Name | Chris William Rehm |
First Address | Ukiah, CA 95482-4509 |
Second Address | Ukiah, CA 95482-4509 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2007 |
Last Update Date | 11/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DX005616F | (05) | CA |