Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1013227776 |
---|---|
Provider Name | Kevin Cutler |
First Address | Santa Cruz, CA 95062-1323 |
Second Address | Santa Cruz, CA 95062-1323 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2010 |
Last Update Date | 15/10/2010 |