Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OE00008371T | PA |
N | 156F00000X | Technician/Technologist | ||
N | 156FC0800X | Contact Lens | ||
N | 156FX1800X | Optician |
NPI | 1831537851 |
---|---|
Provider Name | Mr. Ajay Gauba |
First Address | Bethlehem, PA 18020-8838 |
Second Address | Exton, PA 19341-2442 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2013 |
Last Update Date | 12/06/2013 |