Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 2220 | NC |
NPI | 1003102633 |
---|---|
Provider Name | David R Daughtry JR. |
First Address | Lexington, NC 27292-4112 |
Second Address | Lexington, NC 27292-4401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2011 |
Last Update Date | 27/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5918628 | (05) | NC |