Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 10083 | CA |
NPI | 1013038405 |
---|---|
Provider Name | Dr. Scott Randall Hultman |
First Address | Fresno, CA 93720-0469 |
Second Address | Fresno, CA 93726-5304 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 08/07/2007 |