Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | C0031841 | NY |
NPI | 1134296494 |
---|---|
Provider Name | Mr. Joseph Edward Divietro |
First Address | Auburn, NY 13021-3683 |
Second Address | Auburn, NY 13021-3683 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 08/07/2007 |