Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 008017 | NY |
NPI | 1104481753 |
---|---|
Provider Name | Felipe Solano De La Sala |
First Address | Austin, TX 78753-2658 |
Second Address | Hicksville, NY 11801-4011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2019 |
Last Update Date | 08/05/2019 |