Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | KY-1292 | KY |
NPI | 1073666053 |
---|---|
Provider Name | Mr. Joel L. Langham |
First Address | Burgin, KY 40310-0551 |
Second Address | Danville, KY 40422-2160 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2007 |
Last Update Date | 08/07/2007 |