Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1093060980 |
---|---|
Provider Name | Lanning Blish |
First Address | Harlingen, TX 78552-7466 |
Second Address | Harlingen, TX 78552 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2012 |
Last Update Date | 17/07/2012 |