Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 005611-1 | NY |
NPI | 1104099555 |
---|---|
Provider Name | Mr. Kevin Hanrahan |
First Address | Hornell, NY 14843-2252 |
Second Address | Hornell, NY 14843-2252 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2008 |
Last Update Date | 07/04/2008 |