Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 2005-SC | OH |
NPI | 1013109198 |
---|---|
Provider Name | Mr. Edward J Nowak |
First Address | Toledo, OH 43606-2925 |
Second Address | Toledo, OH 43606-2925 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2007 |
Last Update Date | 28/12/2007 |