Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | DR1478 | TX |
NPI | 1033311063 |
---|---|
Provider Name | Mr. Emery M. Anderson SR. |
First Address | Beaumont, TX 77706-5962 |
Second Address | Beaumont, TX 77706-5962 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0873990001 | (02) | TX |
7414560049 | EIN (01) | TX |