Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 56007594 | NY |
Y | 152W00000X | Optometrist | TUV007594 | NY |
NPI | 1003128935 |
---|---|
Provider Name | Kristy May Dean |
First Address | Ithaca, NY 14850-8795 |
Second Address | Ithaca, NY 14850-8795 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2010 |
Last Update Date | 16/04/2019 |