Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 0086631 | NY |
NPI | 1033308796 |
---|---|
Provider Name | Crystal Lai |
First Address | New York, NY 10013-3762 |
Second Address | Brooklyn, NY 11214-4310 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2007 |
Last Update Date | 18/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02910649 | (05) | NY |