Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | DO1580 | FL |
NPI | 1154595593 |
---|---|
Provider Name | Mr. Clarke Glatt |
First Address | Apopka, FL 32703-4958 |
Second Address | Apopka, FL 32703-4958 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2008 |
Last Update Date | 16/04/2008 |