Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1144534892 |
---|---|
Provider Name | Kathryn Branch Casey |
First Address | Socorro, NM 87801 |
Second Address | Socorro, NM 87801-5004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2010 |
Last Update Date | 04/08/2010 |