Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1023249513 |
---|---|
Provider Name | Jacob T Reese |
First Address | Wichita, KS 67203-3601 |
Second Address | Wichita, KS 67203-3601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2009 |
Last Update Date | 31/07/2009 |