Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FC0801X | Contact Lens Fitter | 6000007707 | PA |
Y | 156FX1800X | Optician | 6000007707 | PA |
NPI | 1164722971 |
---|---|
Provider Name | Mr. James Thomas Canella |
First Address | Erie, PA 16508-2020 |
Second Address | Erie, PA 16508-2020 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2010 |
Last Update Date | 26/10/2010 |