Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FX1800X | Optician | 008241-1 | NY |
Y | 156FX1800X | Optician | 0082411 | NY |
NPI | 1164938890 |
---|---|
Provider Name | Megan Kathleen O'donnell |
First Address | Islandia, NY 11749-1513 |
Second Address | Islandia, NY 11749-1513 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2017 |
Last Update Date | 18/12/2017 |