Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1700X | Ocularist |
NPI | 1770189961 |
---|---|
Provider Name | John Trawnik |
First Address | Dallas, TX 75206-5037 |
Second Address | Dallas, TX 75206-5037 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2020 |
Last Update Date | 07/07/2021 |