Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 237 | NV |
NPI | 1003901851 |
---|---|
Provider Name | Dr. Aaron Mancuso |
First Address | Henderson, NV 89052-5944 |
Second Address | Henderson, NV 89052-5944 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 10/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002502013 | (05) | NV |
U87765 | (02) | NV |