Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 451 | KY |
NPI | 1235129776 |
---|---|
Provider Name | Donna Davis |
First Address | Glasgow, KY 42141-3478 |
Second Address | Glasgow, KY 42141-3478 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
451 | OPTICIAN LICENSE (01) | KY |