Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FC0801X | Contact Lens Fitter | C0036231 | NY |
NPI | 1174694681 |
---|---|
Provider Name | Mr. Dennis Osiak |
First Address | Williamsville, NY 14221-6012 |
Second Address | Williamsville, NY 14221-6012 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 24/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00608851 | (05) | NY |