Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 007280-1 | NY |
NPI | 1154837342 |
---|---|
Provider Name | James Lawrence Basham |
First Address | Batavia, NY 14020 |
Second Address | Batavia, NY 14020-1253 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2017 |
Last Update Date | 26/12/2017 |