Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | D 6860 | CA |
NPI | 1023158060 |
---|---|
Provider Name | Gennady Gary Bdil |
First Address | Los Angeles, CA 90036-1716 |
Second Address | Los Angeles, CA 90036-1716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DX006860F | (05) | CA |