Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | C003507 | NY |
NPI | 1124248760 |
---|---|
Provider Name | Mr. Carl Richard Endres |
First Address | Hamburg, NY 14075-3641 |
Second Address | West Seneca, NY 14224-4624 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2007 |
Last Update Date | 08/07/2007 |