Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | DO 6465 | FL |
NPI | 1053731679 |
---|---|
Provider Name | Jason Holman |
First Address | Orlando, FL 32805-1612 |
Second Address | Orlando, FL 32805-1612 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2014 |
Last Update Date | 22/04/2014 |