Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 4665 | NY |
NPI | 1013091347 |
---|---|
Provider Name | Mr. Edmund L Lasek JR. |
First Address | Utica, NY 13502 |
Second Address | Utica, NY 13502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01486488 | (05) | NY |