Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 009898 | NY |
NPI | 1023644291 |
---|---|
Provider Name | Martha Canon |
First Address | Austin, TX 78753-2658 |
Second Address | New York, NY 10018-2301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2020 |
Last Update Date | 19/03/2020 |