Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 009783 | NY |
NPI | 1164919114 |
---|---|
Provider Name | Kristina Marie Ackerman |
First Address | Webster, NY 14580-2316 |
Second Address | Webster, NY 14580-2316 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2018 |
Last Update Date | 16/04/2018 |