Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 046010522 | IL |
N | 152W00000X | Optometrist | 0618002098 | VA |
N | 152W00000X | Optometrist | 7999538-9934 | UT |
N | 152W00000X | Optometrist | OP1000233 | DC |
N | 152W00000X | Optometrist | OPT0002942 | CO |
Y | 152W00000X | Optometrist | TA2283 | MD |
NPI | 1003102757 |
---|---|
Provider Name | David Zachary Ephraim |
First Address | Silver Spring, MD 20904-6220 |
Second Address | Kensington, MD 20895-2467 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2011 |
Last Update Date | 29/07/2013 |