Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 9511T | CA |
NPI | 1346434909 |
---|---|
Provider Name | George Shunda |
First Address | Newport Beach, CA 92663-2732 |
Second Address | Newport Beach, CA 92663-2732 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2007 |
Last Update Date | 28/08/2007 |