Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | TUV003442 | NY |
NPI | 1003812223 |
---|---|
Provider Name | Dr. Stephen J Fine |
First Address | Kingston, NY 12401-3942 |
Second Address | Kingston, NY 12401-3942 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2005 |
Last Update Date | 20/05/2013 |