Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | C-007731-1 | NY |
NPI | 1003322868 |
---|---|
Provider Name | David Puchala |
First Address | Henrietta, NY 14467-9503 |
Second Address | Webster, NY 14580-1986 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2017 |
Last Update Date | 15/12/2017 |