Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 007430 | NY |
NPI | 1144526799 |
---|---|
Provider Name | David Debellis |
First Address | Rochester, NY 14624-5442 |
Second Address | Rochester, NY 14624-5442 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2011 |
Last Update Date | 30/01/2011 |