Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 003810-0 | NY |
NPI | 1144201500 |
---|---|
Provider Name | Mr. Derek C Lindell |
First Address | Forest Hills, NY 11375-3757 |
Second Address | Forest Hills, NY 11375-3757 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2005 |
Last Update Date | 14/11/2007 |