Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 007936-1 | NY |
NPI | 1194299909 |
---|---|
Provider Name | Macie Ann Graziadei |
First Address | Grand Island, NY 14072-2854 |
Second Address | Niagara Falls, NY 14304-4704 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2019 |
Last Update Date | 15/01/2019 |