Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | RI0114 | RI |
NPI | 1013164359 |
---|---|
Provider Name | John J Lynch JR. |
First Address | North Kingstown, RI 02852-3220 |
Second Address | North Kingstown, RI 02852-3220 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2008 |
Last Update Date | 19/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PV13450 | (05) | RI |