Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FC0801X | Contact Lens Fitter | ||
Y | 156FX1800X | Optician |
NPI | 1306490487 |
---|---|
Provider Name | Matias Reinhardt |
First Address | Deer Park, TX 77536-4806 |
Second Address | Deer Park, TX 77536-4806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2019 |
Last Update Date | 28/07/2019 |