Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | TA0780 | MD |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | TA0780 | MD |
N | 152WP0200X | Pediatric Optomitrist | TA0780 | MD |
N | 152WS0006X | Sports Vision | TA0780 | MD |
N | 152WX0102X | Occupational Vision | TA0780 | MD |
NPI | 1013057728 |
---|---|
Provider Name | Dr. Paul Nenner |
First Address | Baltimore, MD 21212-1511 |
Second Address | Baltimore, MD 21206-5936 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U51418 | (02) | MD |