Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OPC 3909 | FL |
NPI | 1003943242 |
---|---|
Provider Name | Dr. Jennifer Elaine Lage-Salty |
First Address | Weston, FL 33326 |
Second Address | Weston, FL 33326 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2007 |
Last Update Date | 11/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
621087200 | (05) | FL |
V07869 | (02) | FL |