Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FC0800X | Contact Lens | 599 | SC |
N | 156FC0801X | Contact Lens Fitter | 599 | SC |
Y | 156FX1800X | Optician | 1219 | SC |
NPI | 1366014672 |
---|---|
Provider Name | Mr. Christopher Wayne Enzor |
First Address | Florence, SC 29501 |
Second Address | Florence, SC 29501-4043 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2021 |
Last Update Date | 15/07/2021 |