Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 35-1762626 | IN |
NPI | 1225154891 |
---|---|
Provider Name | Mr. Daniel J. Federspill |
First Address | Greenwood, IN 46142-9427 |
Second Address | Greenwood, IN 46142-9427 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2007 |
Last Update Date | 25/08/2008 |