Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OPT633 | ME |
NPI | 1013059096 |
---|---|
Provider Name | Dr. Daniel P. Roy |
First Address | Sanford, ME 04073-3612 |
Second Address | Sanford, ME 04073-3612 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2007 |
Last Update Date | 01/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
114270000 | (05) | ME |
T31694 | (02) | ME |