Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 1001 | SC |
NPI | 1225519564 |
---|---|
Provider Name | Dawn Marie Marentette |
First Address | Florence, SC 29501-4638 |
Second Address | Florence, SC 29501-3429 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2018 |
Last Update Date | 24/08/2018 |