Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 3103 | VA |
NPI | 1053588756 |
---|---|
Provider Name | Mr. Daryl Scott Bauer |
First Address | Alexandria, VA 22302-1215 |
Second Address | Alexandria, VA 22302-1215 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2008 |
Last Update Date | 12/05/2008 |