Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 3698 | FL |
NPI | 1053946566 |
---|---|
Provider Name | John David Mounce |
First Address | Pensacola, FL 32514-4744 |
Second Address | Pensacola, FL 32514-4744 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2020 |
Last Update Date | 04/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3800 | (05) | FL |