Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | FLOP0002303 | FL |
N | 152W00000X | Optometrist | OPC2303 | FL |
NPI | 1003804121 |
---|---|
Provider Name | James A Podschun |
First Address | Winter Park, FL 32792-2244 |
Second Address | Winter Park, FL 32792-2244 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2005 |
Last Update Date | 05/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
078735300 | (05) | FL |
U02065 | (02) | FL |