Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1194332445 |
---|---|
Provider Name | Kevin Lee Treat |
First Address | Lake Winola, PA 18625-0517 |
Second Address | Falls, PA 18615-7777 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2020 |
Last Update Date | 29/09/2020 |