Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | DO2342 | FL |
NPI | 1164481123 |
---|---|
Provider Name | Gwendolyn J King |
First Address | Okeechobee, FL 34974-4345 |
Second Address | Okeechobee, FL 34974-4345 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2006 |
Last Update Date | 08/07/2007 |