Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 667295596 | PA |
NPI | 1154581288 |
---|---|
Provider Name | Darrell M Sipe |
First Address | Hanover, PA 17331-3160 |
Second Address | Hanover, PA 17331-3160 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2008 |
Last Update Date | 12/06/2008 |