Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OPC2250 | FL |
NPI | 1003921974 |
---|---|
Provider Name | Dr. Dennis Raney |
First Address | Orlando, FL 32803-4376 |
Second Address | Orlando, FL 32803-4376 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 08/07/2007 |