Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1083747919 |
---|---|
Provider Name | Mr. Bryan Dale Huskey |
First Address | Texas City, TX 77590-7142 |
Second Address | Texas City, TX 77590-7142 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2007 |
Last Update Date | 23/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
928908 | (05) | TX |