Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 183993 | CA |
NPI | 1093055238 |
---|---|
Provider Name | Ford Scott Takaichi |
First Address | Capitola, CA 95010-2555 |
Second Address | Capitola, CA 95010-2555 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2013 |
Last Update Date | 25/02/2013 |