Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OPT001798 | GA |
NPI | 1003875386 |
---|---|
Provider Name | Dr. Ian Buchli |
First Address | Brunswick, GA 31525-1993 |
Second Address | Brunswick, GA 31525-1993 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2006 |
Last Update Date | 23/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000954291A | (05) | GA |
000954291B | (05) | GA |
U74150 | (02) |