Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1013209220 |
---|---|
Provider Name | Mr. Drake Mclean |
First Address | San Antonio, TX 78216-1691 |
Second Address | San Antonio, TX 78216-1691 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2011 |
Last Update Date | 05/05/2011 |