Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 028-0000295 | VT |
NPI | 1114042348 |
---|---|
Provider Name | Mr. Amjad Mahmoud Hayyat |
First Address | Middlebury, VT 05753-1128 |
Second Address | Middlebury, VT 05753-1215 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1011579 | (05) | VT |