Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 886 | SC |
NPI | 1003802687 |
---|---|
Provider Name | David W Bang |
First Address | Summerville, SC 29485-8545 |
Second Address | Summerville, SC 29485-8545 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2005 |
Last Update Date | 17/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D08864 | (05) | SC |
T83759 | (02) |