Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 7991 | NY |
NPI | 1013293257 |
---|---|
Provider Name | Kevin Alan Greene |
First Address | Port Kent, NY 12975-0176 |
Second Address | Plattsburgh, NY 12901-2318 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2011 |
Last Update Date | 02/11/2011 |