Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 13892T | CA |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | OPT13892TPA | CA |
NPI | 1003940453 |
---|---|
Provider Name | Dr. Lance Mcnaughton |
First Address | Pomona, CA 91766-2007 |
Second Address | Pomona, CA 91766-2007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2007 |
Last Update Date | 25/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CX089Z | MEDICARE PTAN (01) | CA |