Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 31TD00097000 | NJ |
NPI | 1003088584 |
---|---|
Provider Name | Mr. James R Davis JR. |
First Address | Easton, PA 18042-3140 |
Second Address | Easton, PA 18042-3140 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2008 |
Last Update Date | 25/03/2008 |