Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FC0801X | Contact Lens Fitter | 223731 | TX |
NPI | 1033654850 |
---|---|
Provider Name | Edward Carmona |
First Address | Dallas, TX 75231-6055 |
Second Address | Dallas, TX 75231-6055 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2017 |
Last Update Date | 03/01/2017 |