Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1700X | Ocularist |
NPI | 1306364070 |
---|---|
Provider Name | Mr. David Raymond Wyatt |
First Address | Metairie, LA 70002 |
Second Address | Metairie, LA 70002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2017 |
Last Update Date | 23/07/2020 |