Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 2750 | NY |
NPI | 1013086164 |
---|---|
Provider Name | Dr. Charles Joseph Hornberger SR. |
First Address | Boston, NY 14025 |
Second Address | Boston, NY 14025 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T88321 | (02) |