Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 3057 | NY |
NPI | 1144358052 |
---|---|
Provider Name | Douglas G Anne |
First Address | Canandaigua, NY 14424-9702 |
Second Address | Canandaigua, NY 14424-9702 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2007 |
Last Update Date | 08/07/2007 |