Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | N/A | DE |
NPI | 1083885859 |
---|---|
Provider Name | Glenn A Courtney |
First Address | Milford, DE 19963-1757 |
Second Address | Dover, DE 19901-4504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2008 |
Last Update Date | 19/03/2008 |