Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 9300TG | TX |
NPI | 1043739568 |
---|---|
Provider Name | Dr. James Joseph Demarco JR. |
First Address | El Paso, TX 79912-6510 |
Second Address | El Paso, TX 79912-3505 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2017 |
Last Update Date | 15/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9300TG | TEXAS LIC NUMBER (01) | TX |