Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1023216553 |
---|---|
Provider Name | Mary Ann Barcak |
First Address | Richmond, TX 77469-3247 |
Second Address | Richmond, TX 77469-3247 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2007 |
Last Update Date | 01/12/2011 |