Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1023135050 |
---|---|
Provider Name | John Charles Korver |
First Address | Sioux City, IA 51106-4750 |
Second Address | Sioux City, IA 51106-4750 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2007 |
Last Update Date | 08/07/2007 |