Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1073678546 |
---|---|
Provider Name | Frank Robertson |
First Address | Westminster, MD 21157-4601 |
Second Address | Westminster, MD 21157-4601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
210179 | NVA (01) | MD |
40546 | MAMSI,OPTIMUMCHOICE,MDIPA (01) | MD |
813872 | AETNA (01) | MD |