Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 712 | KY |
NPI | 1003155565 |
---|---|
Provider Name | Mr. David Roland Ratliff |
First Address | Pikeville, KY 41501-3265 |
Second Address | Pikeville, KY 41501-3265 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2013 |
Last Update Date | 04/02/2013 |