Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 1294-3 | KS |
NPI | 1003908237 |
---|---|
Provider Name | Dr. Gary L. Beaver |
First Address | Independence, KS 67301-0047 |
Second Address | Independence, KS 67301-3315 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 08/07/2007 |