Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FC0800X | Contact Lens | DO5239 | FL |
Y | 156FX1800X | Optician | DO5239 | FL |
NPI | 1730381708 |
---|---|
Provider Name | Dimitri Garcon |
First Address | Hollywood, FL 33024-2709 |
Second Address | Hollywood, FL 33024-2709 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2007 |
Last Update Date | 24/09/2020 |