Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 008707-1 | NY |
NPI | 1063919397 |
---|---|
Provider Name | Kelly Chichester |
First Address | Warsaw, NY 14569-9336 |
Second Address | Perry, NY 14530-9703 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2018 |
Last Update Date | 12/04/2018 |