Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | D1609 | CA |
NPI | 1174738801 |
---|---|
Provider Name | Mr. John J Yohannes |
First Address | Visalia, CA 93291 |
Second Address | Visalia, CA 93291 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ZZZ74844Z | (05) | CA |