Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 1300 | MA |
NPI | 1073642799 |
---|---|
Provider Name | Mr. Clayton R Canedy |
First Address | Fall River, MA 02720-3126 |
Second Address | Fall River, MA 02720-3126 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0176510001 | (02) | |
1518437 | (05) | MA |