Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 009402-1 | NY |
NPI | 1023525946 |
---|---|
Provider Name | Erin M Fraim |
First Address | Catskill, NY 12414-1755 |
Second Address | Catskill, NY 12414-1755 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2017 |
Last Update Date | 16/06/2018 |