Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 0618001717 | VA |
N | 152W00000X | Optometrist | 7011T | TX |
NPI | 1013090513 |
---|---|
Provider Name | Evan Joel Kaufman |
First Address | Charlottesville, VA 22906-9007 |
Second Address | Charlottesville, VA 22903-3363 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2006 |
Last Update Date | 28/09/2020 |