Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1700X | Ocularist |
NPI | 1023500485 |
---|---|
Provider Name | Mr. Antonio Louis Alcorta I |
First Address | Visalia, CA 93291-5804 |
Second Address | Visalia, CA 93291 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2018 |
Last Update Date | 29/01/2019 |