Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1700X | Ocularist | 331034873 | OK |
N | 224P00000X | Prosthetist | ||
N | 225000000X | Orthotic Fitter | 331034873 | OK |
NPI | 1679520423 |
---|---|
Provider Name | Mr. Henry La Fuente |
First Address | Oklahoma City, OK 73103-4918 |
Second Address | Oklahoma City, OK 73103-4918 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2006 |
Last Update Date | 02/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100807050A | (05) | OK |
1811194368 | GROUP NPI (01) | OK |
331034873 | TAX ID (01) | OK |