Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 007733 | NY |
NPI | 1174705693 |
---|---|
Provider Name | Mr. Charles Robert Trojan |
First Address | Queensbury, NY 12804-1835 |
Second Address | Queensbury, NY 12804-1835 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2007 |
Last Update Date | 27/11/2007 |