Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 09951 |
NPI | 1013062132 |
---|---|
Provider Name | Mr. John J Baab SR. |
First Address | Mountain Top, PA 18707-1127 |
Second Address | Mountain Top, PA 18707-1127 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
112112 | EYEMED (01) | |
200505 | BELBS (01) | |
393134 | NVA (01) |