Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207W00000X | Ophthalmologist | 01078022A | IN |
Y | 207WX0107X | Retina Specialist | 01078022A | IN |
NPI | 1003106824 |
---|---|
Provider Name | Dr. Frank N. Hrisomalos |
First Address | Indianapolis, IN 46290-1167 |
Second Address | Indianapolis, IN 46290-1167 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2011 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
300004320 | (05) | IN |