Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 2415 | MA |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 2415 | MA |
NPI | 1336116409 |
---|---|
Provider Name | Dr. John P Herman |
First Address | Pittsfield, MA 01201-6837 |
Second Address | Pittsfield, MA 01201-6837 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2006 |
Last Update Date | 22/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0321133 | (05) | MA |
T59168 | (02) | MA |