Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 001547 | FL |
NPI | 1083707384 |
---|---|
Provider Name | Dr. Richard Alexander Mckyton |
First Address | Naples, FL 34108 |
Second Address | Naples, FL 34108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0531320001 | MDICARE SUPPLIER # (01) | FL |
T84148 | (02) | FL |