Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FC0800X | Contact Lens | 008727-1 | NY |
NPI | 1487056073 |
---|---|
Provider Name | Mr. Chase D Pellow |
First Address | Buffalo, NY 14202 |
Second Address | Buffalo, NY 14202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2014 |
Last Update Date | 25/09/2014 |