Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 008898-1 | NY |
NPI | 1073019642 |
---|---|
Provider Name | Christine Fox |
First Address | Malone, NY 12953-1246 |
Second Address | Malone, NY 12953-1246 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2018 |
Last Update Date | 03/04/2018 |