Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | C008927 | NY |
NPI | 1043721541 |
---|---|
Provider Name | Mr. Christopher J Neal |
First Address | Grand Island, NY 14072-2060 |
Second Address | Grand Island, NY 14072-2060 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2017 |
Last Update Date | 16/06/2018 |