Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | TUV008929 | NY |
NPI | 1013553833 |
---|---|
Provider Name | Joanne Deveau |
First Address | Ozone Park, NY 11416-1739 |
Second Address | Ozone Park, NY 11416-1739 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2019 |
Last Update Date | 27/11/2019 |