Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 008070 | NY |
NPI | 1003303587 |
---|---|
Provider Name | Kelly King |
First Address | Rochester, NY 14618-5630 |
Second Address | Rochester, NY 14618-5630 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2018 |
Last Update Date | 19/04/2018 |