Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | T02862 | MO |
NPI | 1144262536 |
---|---|
Provider Name | Mr. Gerald Robert Gosnell |
First Address | Kansas City, MO 64112-1542 |
Second Address | Kansas City, MO 64112-1542 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 29/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A361897 | (02) | MO |