Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 16132 | SC |
NPI | 1023222734 |
---|---|
Provider Name | Cynthia E Collie |
First Address | Sullivans Island, SC 29482-0187 |
Second Address | Sullinvans Island, SC 29482 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
161327 | (05) | SC |
F73138 | (02) | SC |