Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | FL1858 | FL |
NPI | 1154358893 |
---|---|
Provider Name | Mr. Dean W Earl |
First Address | Vero Beach, FL 32960-6219 |
Second Address | Vero Beach, FL 32960-6219 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2006 |
Last Update Date | 08/07/2007 |