Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 1101002897 | VA |
NPI | 1174891295 |
---|---|
Provider Name | Mr. Bernhard J Urban |
First Address | Chester, VA 23831-5369 |
Second Address | Chester, VA 23831-5369 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2011 |
Last Update Date | 03/12/2011 |