Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 006946-1 | NY |
NPI | 1164919023 |
---|---|
Provider Name | Janet Rodger |
First Address | Warsaw, NY 14569-9336 |
Second Address | Dansville, NY 14437-9503 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2018 |
Last Update Date | 17/04/2018 |