Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 2001006508 | MO |
NPI | 1346334166 |
---|---|
Provider Name | Dr. Amir Sahba Jalali |
First Address | Columbia, MO 65203-2548 |
Second Address | Columbia, MO 65203-2548 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 01/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U61249 | (02) | MO |