Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 07 00002439 | CA |
NPI | 1083731806 |
---|---|
Provider Name | Jack Lee Mcgee |
First Address | Bakersfield, CA 93301-3149 |
Second Address | Bakersfield, CA 93301-3149 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DX002788F | (05) | CA |