Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 009131 | NY |
NPI | 1154986883 |
---|---|
Provider Name | Gurpreet Japra |
First Address | Austin, TX 78753-2658 |
Second Address | North Baldwin, NY 11510-2453 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2019 |
Last Update Date | 08/05/2019 |