Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 05717 | CO |
NPI | 1033294251 |
---|---|
Provider Name | Mr. Clinton A. Aluise |
First Address | Grand Junction, CO 81501-7948 |
Second Address | Grand Junction, CO 81501-7400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 08/07/2007 |