Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 015066 |
NPI | 1184905119 |
---|---|
Provider Name | Kimberly Elaine Burford |
First Address | Saint Louis, MO 63139-3043 |
Second Address | Saint Louis, MO 63139-3043 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2011 |
Last Update Date | 05/09/2011 |