Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OEG001597 | PA |
NPI | 1013483387 |
---|---|
Provider Name | Dr. Mary Huang |
First Address | Paoli, PA 19301-1518 |
Second Address | Paoli, PA 19301-1518 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2018 |
Last Update Date | 15/10/2018 |