Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 2342 | WI |
NPI | 1306966379 |
---|---|
Provider Name | Maria Martha Steck |
First Address | New Berlin, WI 53151-6882 |
Second Address | Wauwatosa, WI 53226-1409 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2007 |
Last Update Date | 29/06/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2342 | STATE LICENSE (01) | WI |