Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1043331432 |
---|---|
Provider Name | Mr. Gary Mons |
First Address | Mandeville, LA 70471-7781 |
Second Address | Mandeville, LA 70471-7781 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 08/07/2007 |