Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 3995T973 | OH |
NPI | 1083675219 |
---|---|
Provider Name | Dr. Thomas Glenn Stine I |
First Address | Pataskala, OH 43062-9141 |
Second Address | Zanesville, OH 43701-7019 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2006 |
Last Update Date | 03/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0782245 | (05) | OH |
T69811 | (02) |