Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 7837 | CA |
NPI | 1003928318 |
---|---|
Provider Name | Eric Lunchick |
First Address | Northridge, CA 91324-3311 |
Second Address | Northridge, CA 91324-3311 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
SD0078370 | (05) | CA |
U61201 | (02) | CA |