Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 25023 | OK |
NPI | 1033259114 |
---|---|
Provider Name | Dr. Grant Nash Corning |
First Address | Ada, OK 74820-2636 |
Second Address | Ada, OK 74820-2646 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2007 |
Last Update Date | 18/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200122220A | (05) | OK |