Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1225602592 |
---|---|
Provider Name | Collin J Whitehair I |
First Address | Durango, CO 81303-6698 |
Second Address | Durango, CO 81303-6698 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2021 |
Last Update Date | 19/05/2021 |