Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 1844 | NC |
NPI | 1225259328 |
---|---|
Provider Name | Mr. Andres Quintana |
First Address | Wake Forest, NC 27587-9494 |
Second Address | Wake Forest, NC 27587-9494 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 08/07/2007 |