Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 008203-1 | NY |
NPI | 1134231624 |
---|---|
Provider Name | Heather Marie Gayne |
First Address | Schenectady, NY 12309-6247 |
Second Address | Schenectady, NY 12309-6247 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 03/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02745146 | (05) | NY |
02745155 | (05) | NY |