Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 4865T | CA |
NPI | 1003899006 |
---|---|
Provider Name | James Forte |
First Address | Hanford, CA 93230-5904 |
Second Address | Lemoore, CA 93245-2931 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2005 |
Last Update Date | 09/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
SD0048650 | (05) | CA |
T09803 | (02) |