Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | NY006945-1 | NY |
NPI | 1114100021 |
---|---|
Provider Name | Isaias Lope |
First Address | Jackson Heights, NY 11372-7320 |
Second Address | Jackson Heights, NY 11372-7320 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2007 |
Last Update Date | 13/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02220762 | (05) | NY |