Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1053319772 |
---|---|
Provider Name | Mr. Alberto Antman |
First Address | Wilmette, IL 60091-3050 |
Second Address | Wilmette, IL 60091-3050 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 08/07/2007 |