Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1154623130 |
---|---|
Provider Name | Mark Thompson |
First Address | Kalispell, MT 59901-1218 |
Second Address | Kalispell, MT 59901-1218 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/11/2010 |
Last Update Date | 27/02/2015 |