Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FC0800X | Contact Lens | 156FC0800X | AK |
NPI | 1922610021 |
---|---|
Provider Name | Elizabeth Rose Larson |
First Address | Anchorage, AK 99517-2467 |
Second Address | Anchorage, AK 99517-2467 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2020 |
Last Update Date | 19/08/2020 |