Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 29567 | TX |
NPI | 1114061066 |
---|---|
Provider Name | Clifton Joseph Kochinsky |
First Address | Houston, TX 77033-1045 |
Second Address | Houston, TX 77033-1045 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2007 |
Last Update Date | 12/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0661696-01 | (05) | TX |