Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FC0800X | Contact Lens | DO 3905 | FL |
N | 156FX1101X | Ophthalmic Assistant | DO 3905 | FL |
N | 156FX1202X | Optometric Technician | DO 3905 | FL |
Y | 156FX1800X | Optician | DO 3905 | FL |
NPI | 1649505520 |
---|---|
Provider Name | Josue Isaias Roja |
First Address | Doral, FL 33166-6625 |
Second Address | Doral, FL 33166-6625 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2009 |
Last Update Date | 19/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001352000 | (05) | FL |