Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 5818 | MA |
NPI | 1144845520 |
---|---|
Provider Name | Kerry Bilski |
First Address | Chicopee, MA 01020-1816 |
Second Address | Chicopee, MA 01020-1816 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2020 |
Last Update Date | 11/06/2020 |