Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 3410-35 | WI |
NPI | 1003264318 |
---|---|
Provider Name | Dr. Paul Hubert Payant |
First Address | Oshkosh, WI 54902-4174 |
Second Address | Oshkosh, WI 54902-4174 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2016 |
Last Update Date | 26/05/2016 |