Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 1101000503 | VA |
NPI | 1124159504 |
---|---|
Provider Name | Mr. Loyd Paul Quillen |
First Address | Harrisonburg, VA 22802 |
Second Address | Harrisonburg, VA 22802 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2007 |
Last Update Date | 24/09/2008 |