Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 172500 | TX |
NPI | 1053536417 |
---|---|
Provider Name | Mr. David Black |
First Address | Seabrook, TX 77586-4014 |
Second Address | Seabrook, TX 77586-4014 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2007 |
Last Update Date | 08/07/2007 |