Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 3503 | NY |
NPI | 1033217351 |
---|---|
Provider Name | Mary K Hart |
First Address | Syracuse, NY 13203-2087 |
Second Address | Syracuse, NY 13203-2087 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 10/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1295723534 | GROUP PRACTICE NPI (01) | NY |