Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1043559032 |
---|---|
Provider Name | Marian L Davis |
First Address | Raleigh, NC 27615-6156 |
Second Address | Durham, NC 27710-4699 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2013 |
Last Update Date | 11/02/2013 |