Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | DO2644 | FL |
NPI | 1124267612 |
---|---|
Provider Name | Mr. David Bodnarchuk |
First Address | Naples, FL 34119-8601 |
Second Address | Naples, FL 34109-1794 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2009 |
Last Update Date | 06/02/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DO2644 | LICENSE (01) | FL |