Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 101 | VA |
NPI | 1215091814 |
---|---|
Provider Name | Gysbertus Johann Metten |
First Address | Richmond, VA 23235 |
Second Address | Richmond, VA 23235 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2006 |
Last Update Date | 18/01/2008 |