Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 817 | FL |
NPI | 1063436368 |
---|---|
Provider Name | Dr. Lloyd Firestone |
First Address | Tampa, FL 33613-1626 |
Second Address | Tampa, FL 33613-1626 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 13/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
084102100 | (05) | FL |