Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1053553453 |
---|---|
Provider Name | Lisa Cuda Mccarron |
First Address | Madison, WI 53719-4614 |
Second Address | Fitchburg, WI 53711-5336 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2009 |
Last Update Date | 31/03/2009 |