Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 973 | AZ |
NPI | 1003986183 |
---|---|
Provider Name | Jill Rago |
First Address | Scottsdale, AZ 85262-5693 |
Second Address | Scottsdale, AZ 85255-3881 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2006 |
Last Update Date | 16/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Z63808 | (02) | AZ |