Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 005703-1 | NY |
NPI | 1184121477 |
---|---|
Provider Name | Dave Bezner |
First Address | Warsaw, NY 14569-9336 |
Second Address | Batavia, NY 14020-1613 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2018 |
Last Update Date | 12/04/2018 |