Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OPC3234 | FL |
NPI | 1013135409 |
---|---|
Provider Name | Kirk Gopie |
First Address | Florida City, FL 33034-5628 |
Second Address | Florida City, FL 33034-5628 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2007 |
Last Update Date | 28/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001277900 | (05) | FL |