Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 110343 | KY |
NPI | 1215474606 |
---|---|
Provider Name | David Thompson |
First Address | Glasgow, KY 42141-3412 |
Second Address | Glasgow, KY 42141-3412 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2017 |
Last Update Date | 24/01/2017 |