Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 008275 | NY |
NPI | 1013423193 |
---|---|
Provider Name | Melissa Lee Gromacki |
First Address | Kingston, NY 12401-1550 |
Second Address | Kingston, NY 12401-1550 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2017 |
Last Update Date | 27/12/2017 |