Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 203 | SC |
NPI | 1023292166 |
---|---|
Provider Name | Mr. Daniel Bruce Gosnell |
First Address | Greenville, SC 29605 |
Second Address | Greenville, SC 29605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2007 |
Last Update Date | 26/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DV0203 | (05) | SC |