Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | MA4163 | MA |
NPI | 1154571925 |
---|---|
Provider Name | Mr. David W Dougan |
First Address | Orange, MA 01364-9603 |
Second Address | Orange, MA 01364-9603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2008 |
Last Update Date | 29/09/2008 |