Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FX1800X | Optician | 003234 | NY |
NPI | 1124057468 |
---|---|
Provider Name | Mr. John M Carter |
First Address | Baldwinsville, NY 13027-2437 |
Second Address | Baldwinsville, NY 13027-2437 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01608084 | (05) | NY |
01636433 | (05) | NY |