Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 7364T | CA |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 7364T | CA |
N | 152WP0200X | Pediatric Optomitrist | 7364T | CA |
N | 152WS0006X | Sports Vision | 7364T | CA |
N | 152WX0102X | Occupational Vision | 7364T | CA |
NPI | 1245200302 |
---|---|
Provider Name | Dr. Donald Edward Stover |
First Address | Porterville, CA 93257-3274 |
Second Address | Porterville, CA 93257-3274 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2006 |
Last Update Date | 27/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
SD0073640 | (05) | CA |
T10517 | (02) | CA |