Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 2804 | FL |
NPI | 1104010719 |
---|---|
Provider Name | Joyce Ann Mccaffrey |
First Address | Venice, FL 34285-4635 |
Second Address | Venice, FL 34285-4635 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2007 |
Last Update Date | 28/08/2007 |