Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FC0800X | Contact Lens | ||
Y | 156FX1800X | Optician |
NPI | 1225406994 |
---|---|
Provider Name | Joel Scalf |
First Address | Amarillo, TX 79107-6987 |
Second Address | Amarillo, TX 79107-6987 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2015 |
Last Update Date | 11/09/2015 |