Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 7221T | CA |
NPI | 1326158478 |
---|---|
Provider Name | Dr. Milton Hom |
First Address | Azusa, CA 91702-2706 |
Second Address | Azusa, CA 91702-2706 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 21/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
SD0072210 | (05) | CA |
T70182 | (02) | CA |