Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1700X | Ocularist | 09-336-15 | IA |
NPI | 1124345756 |
---|---|
Provider Name | John Stolpe |
First Address | Tarzana, CA 91356-6627 |
Second Address | Tarzana, CA 91356-6627 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2010 |
Last Update Date | 01/10/2010 |