Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 004127-1 | NY |
NPI | 1033277629 |
---|---|
Provider Name | Mr. Gary H Nelson |
First Address | Jamestown, NY 14701-2623 |
Second Address | Jamestown, NY 14701-2623 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 03/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00622124 | (05) | NY |