Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | TUV009365 | NY |
NPI | 1013586015 |
---|---|
Provider Name | Dr. Taylor Michael Davis |
First Address | Kingston, NY 12401-2136 |
Second Address | Kingston, NY 12401-1571 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2021 |
Last Update Date | 23/06/2021 |