Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | OEG001966 | PA |
NPI | 1326035882 |
---|---|
Provider Name | Dr. John Peter Roman |
First Address | Philadelphia, PA 19107-3011 |
Second Address | Philadelphia, PA 19107-3011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2005 |
Last Update Date | 28/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
593670 | PA BLUE CROSS/BLUE SHIELD (01) | PA |