Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FC0801X | Contact Lens Fitter | C4579 | NY |
N | 156FX1800X | Optician | C4579 | NY |
NPI | 1760506760 |
---|---|
Provider Name | Mr. Carl Rothman |
First Address | Bellmore, NY 11710-5103 |
Second Address | Oakland Gardens, NY 11364-2947 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2007 |
Last Update Date | 08/07/2007 |