Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 959 | SC |
NPI | 1144792243 |
---|---|
Provider Name | Jennifer Rauchut |
First Address | Moncks Corner, SC 29461-8888 |
Second Address | Summerville, SC 29483-7362 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2018 |
Last Update Date | 30/12/2018 |