Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | S7225 | OH |
NPI | 1104123918 |
---|---|
Provider Name | Julia Marie Beverick II |
First Address | Sandusky, OH 44870-3362 |
Second Address | Sandusky, OH 44870-3362 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2011 |
Last Update Date | 15/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2275943 | (05) | OH |