Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 027974 | CO |
NPI | 1124217518 |
---|---|
Provider Name | Mr. Kenneth Dale Aipperspach |
First Address | Boulder, CO 80303-1082 |
Second Address | Boulder, CO 80303-1082 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2007 |
Last Update Date | 22/10/2007 |