Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1154530681 |
---|---|
Provider Name | Mr. Glynn E. Jones SR. |
First Address | Jackson, MS 39209-4806 |
Second Address | Jackson, MS 39209-4806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00880219 | (05) | MS |