Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 008573-1 | NY |
NPI | 1043726672 |
---|---|
Provider Name | Mr. George Scott Harris JR. |
First Address | Camillus, NY 13031-2265 |
Second Address | Camillus, NY 13031-2265 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2017 |
Last Update Date | 19/12/2017 |