Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 18003206 | IN |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 18003206 | IN |
NPI | 1164616900 |
---|---|
Provider Name | Dr. David Roger Britzke |
First Address | Elkhart, IN 46516-9343 |
Second Address | Elkhart, IN 46516-9343 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2007 |
Last Update Date | 17/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200393840A | (05) | IN |
U92995 | (02) | IN |