Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FC0801X | Contact Lens Fitter | NY007505 | NY |
Y | 156FX1800X | Optician | NY007505 | NY |
NPI | 1003158692 |
---|---|
Provider Name | Doris Prashaw |
First Address | Ogdensburg, NY 13669-1620 |
Second Address | Ogdensburg, NY 13669-1620 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2013 |
Last Update Date | 05/04/2019 |