Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | S319TA226 | AL |
NPI | 1003896838 |
---|---|
Provider Name | Jane W. Lamb |
First Address | Luverne, AL 36049-1602 |
Second Address | Luverne, AL 36049-1602 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2006 |
Last Update Date | 13/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T68959 | (02) | AL |