Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1205832771 |
---|---|
Provider Name | David Gardner |
First Address | Franklin, PA 16323-1335 |
Second Address | Franklin, PA 16323-1335 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2005 |
Last Update Date | 10/03/2008 |