Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | DO7476 | FL |
NPI | 1154903086 |
---|---|
Provider Name | Danielle N Graham |
First Address | Inverness, FL 34450-6307 |
Second Address | Inverness, FL 34453-3216 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2021 |
Last Update Date | 21/04/2021 |