Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 712 | AZ |
NPI | 1114107059 |
---|---|
Provider Name | Mr. Dan Horvath |
First Address | Phoenix, AZ 85022-2300 |
Second Address | Phoenix, AZ 85022-2300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2007 |
Last Update Date | 08/11/2007 |