Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 734 | SC |
NPI | 1063681500 |
---|---|
Provider Name | Laura Meade Heaton |
First Address | Seneca, SC 29678-0929 |
Second Address | Seneca, SC 29678-0929 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2008 |
Last Update Date | 28/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DV7396 | (05) | SC |