Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FC0800X | Contact Lens | ||
Y | 156FX1800X | Optician |
NPI | 1548547516 |
---|---|
Provider Name | Mr. Abel Hernandez |
First Address | Columbia, MD 21044 |
Second Address | Anacostia, DC 20020 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2011 |
Last Update Date | 25/04/2012 |