Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 1101001399 | VA |
NPI | 1083645097 |
---|---|
Provider Name | Mary Margaret Rector |
First Address | Galax, VA 24333-2231 |
Second Address | Galax, VA 24333-2231 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 08/07/2007 |