Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 1423 DT | KY |
NPI | 1013045491 |
---|---|
Provider Name | Dr. Fiona S Boak |
First Address | Louisville, KY 40241-3818 |
Second Address | Louisville, KY 40241-3818 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2007 |
Last Update Date | 11/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
77001444 | (05) | KY |
V05419 | (02) |