Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 1101 002127 | VA |
NPI | 1174649446 |
---|---|
Provider Name | Damon Cannady |
First Address | Colonial Heights, VA 23834-3617 |
Second Address | Colonial Heights, VA 23834-3617 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2007 |
Last Update Date | 08/07/2007 |