Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 006417-1 | NY |
NPI | 1093938086 |
---|---|
Provider Name | Marvea V Thompson |
First Address | Freeport, NY 11520-1913 |
Second Address | Valley Stream, NY 11581-1531 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2007 |
Last Update Date | 01/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02000439 | (05) | NY |