Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 4804TG | TX |
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 4804TG | TX |
NPI | 1215927264 |
---|---|
Provider Name | David Cannon Fram |
First Address | Waco, TX 76705-3207 |
Second Address | Waco, TX 76705-3207 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2005 |
Last Update Date | 30/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036640302 | (05) | TX |
U54622 | (02) | TX |