Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 007575-1 | NY |
NPI | 1083188171 |
---|---|
Provider Name | Janet Marie Klispie |
First Address | Hamburg, NY 14075-3596 |
Second Address | Hamburg, NY 14075-3596 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2019 |
Last Update Date | 11/01/2019 |