Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 009867 | NY |
NPI | 1316583552 |
---|---|
Provider Name | Jorge Silva |
First Address | Elmsford, NY 10523-2321 |
Second Address | Bronx, NY 10467-1002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2019 |
Last Update Date | 22/11/2019 |