Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 005876-1 | NY |
NPI | 1023116787 |
---|---|
Provider Name | Mr. Christopher Williams |
First Address | Staten Island, NY 10314-3514 |
Second Address | Staten Island, NY 10314-3514 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01573977 | (05) | NY |