Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | OPC3209 | FL |
NPI | 1063521201 |
---|---|
Provider Name | Dr. Nicole L Beedle |
First Address | Orlando, FL 32803-5313 |
Second Address | Orlando, FL 32803-5313 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 19/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U71806 | (02) | FL |