Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | ND 378 | ND |
NPI | 1003085523 |
---|---|
Provider Name | John Gregory Dye |
First Address | West Fargo, ND 58078-3145 |
Second Address | West Fargo, ND 58078-3145 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2008 |
Last Update Date | 28/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
60533 | (05) | ND |
P66866 | (02) | ND |