Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 2794 | CA |
NPI | 1225105117 |
---|---|
Provider Name | Mr. Kenneth H Quigley |
First Address | Bakersfield, CA 93308-2653 |
Second Address | Bakersfield, CA 93308-2653 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DX002794F | (05) | CA |