Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FC0801X | Contact Lens Fitter | DO7147 | |
Y | 156FX1800X | Optician | DO7147 |
NPI | 1679050082 |
---|---|
Provider Name | Melissa Cole |
First Address | Lake City, FL 32025-4203 |
Second Address | Lake City, FL 32025-4203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2018 |
Last Update Date | 27/07/2018 |