Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 005220 | NY |
NPI | 1003873837 |
---|---|
Provider Name | Jennifer L. Leuzzi |
First Address | Dansville, NY 14437-1756 |
Second Address | Dansville, NY 14437-1756 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 25/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103047CT | PREFERRED CARE (01) | NY |
MOP14M144 | BLUE CROSS-SHIELD (01) | NY |