Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | DO2776 | FL |
NPI | 1013119692 |
---|---|
Provider Name | Larry Chumney |
First Address | Winter Haven, FL 33880-4126 |
Second Address | Winter Haven, FL 33880-4126 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2007 |
Last Update Date | 08/07/2007 |