Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 27OA00685000 | NJ |
N | 152W00000X | Optometrist | TUV008709 | NY |
NPI | 1003320136 |
---|---|
Provider Name | Clare Tao |
First Address | Jersey City, NJ 07302-1649 |
Second Address | West New York, NJ 07093-1448 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2017 |
Last Update Date | 12/11/2020 |