Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | OPC3206 | FL |
Y | 152W00000X | Optometrist | OPT001797 | GA |
NPI | 1013078575 |
---|---|
Provider Name | Dr. Robert R. Assantes |
First Address | Thomasville, GA 31792-4807 |
Second Address | Thomasville, GA 31792-4807 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2006 |
Last Update Date | 19/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000901337E | (05) | GA |
U73391 | (02) | FL |