Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FC0801X | Contact Lens Fitter | C005349-1 | NY |
N | 156FX1800X | Optician | C005349-1 | NY |
NPI | 1902920846 |
---|---|
Provider Name | Mr. Eugene F Young |
First Address | Medina, NY 14103-1416 |
Second Address | Medina, NY 14103-1416 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01535657 | (05) | NY |