Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1053506386 |
---|---|
Provider Name | James L. Heil |
First Address | Durant, OK 74701-5022 |
Second Address | Durant, OK 74701-5022 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2007 |
Last Update Date | 10/09/2007 |