Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 1101 001595 | VA |
NPI | 1053576637 |
---|---|
Provider Name | Miss Patricia Guin Edwards |
First Address | Richmond, VA 23238-4919 |
Second Address | Richmond, VA 23238-4919 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2008 |
Last Update Date | 23/07/2008 |